Kenneth Michael Puccini

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

062116851 Issued in GA

Practice address

2704 N Oak St BLDG A1
Valdosta, GA 31602-5901

Phone

(229) 474-4384

NPI assigned

May 26, 2021

Last updated

May 26, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621987200000",
    "number": "1780259234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2704 N OAK ST BLDG A1",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316025901",
            "telephone_number": "229-474-4384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2704 N OAK ST BLDG A1",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316025901",
            "telephone_number": "229-474-4384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCCINI",
        "first_name": "KENNETH",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-26",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "GA",
            "license": "062116851",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "jencazales@yahoo.com",
            "affiliation": "N",
            "address_1": "2704 N Oak St Bldg A1",
            "city": "Valdosta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "316025901",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Behavior Technician in Valdosta, GA
• Providers in Valdosta, GA by specialty
• Behavior Technician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.