Active NPI
Jeannine Sam, BCBA
- Behavior Analyst
- Danbury, CT
National Provider Identifier
1790197176
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-14-15457
- Practice address
- 16 Blackberry Rd
Danbury, CT 06811-3815 - Phone
- (203) 312-3974
- NPI assigned
- May 20, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-14-15457 | Primary | |
| Specialist | 174400000X | 1139409 | NY |
Addresses
Primary practice location
16 Blackberry Rd
Danbury, CT 06811-3815
Mailing address
16 Blackberry Rd
Danbury, CT 06811-3815
Phone (203) 312-3974
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1139409 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1400544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1400544000000",
"number": "1790197176",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16 BLACKBERRY RD",
"city": "DANBURY",
"state": "CT",
"postal_code": "068113815",
"telephone_number": "203-312-3974"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16 BLACKBERRY RD",
"city": "DANBURY",
"state": "CT",
"postal_code": "068113815",
"telephone_number": "203-312-3974"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAM",
"first_name": "JEANNINE",
"credential": "BCBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-05-20",
"last_updated": "2014-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": "1-14-15457",
"primary": true
},
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "1139409",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Danbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.