Active NPI
Nicquela Roach
- Behavior Technician
- Boston, MA
National Provider Identifier
1831867266
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 11 Whitten St Apt 2
Boston, MA 02122-1122 - Phone
- (617) 980-4665
- NPI assigned
- Aug 31, 2021
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
11 Whitten St Apt 2
Boston, MA 02122-1122
Mailing address
11 Whitten St Apt 2
Boston, MA 02122-1122
Phone (617) 980-4665
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100214200501 | Medicaid | MA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | n/a |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630368000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630368000000",
"number": "1831867266",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 WHITTEN ST APT 2",
"city": "BOSTON",
"state": "MA",
"postal_code": "021221122",
"telephone_number": "617-980-4665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 WHITTEN ST APT 2",
"city": "BOSTON",
"state": "MA",
"postal_code": "021221122",
"telephone_number": "617-980-4665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROACH",
"first_name": "NICQUELA",
"name_prefix": "Miss",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-31",
"last_updated": "2021-08-31",
"certification_date": "2021-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100214200501",
"state": "MA"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "n/a",
"affiliation": "N",
"address_1": "11 Whitten St Apt 2",
"city": "Boston",
"state": "MA",
"country_code": "US",
"postal_code": "021221122",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 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.