Mabel Etuknwa

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-21-51371 Issued in TX

Practice address

121 Summerhill Rd
East Brunswick, NJ 08816-3756

Phone

(877) 111-0399

NPI assigned

Nov 9, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1541721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626998400000",
    "number": "1841768629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 SUMMERHILL RD",
            "city": "EAST BRUNSWICK",
            "state": "NJ",
            "postal_code": "088163756",
            "telephone_number": "877-111-0399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 SUMMERHILL RD",
            "city": "EAST BRUNSWICK",
            "state": "NJ",
            "postal_code": "088163756",
            "telephone_number": "877-111-0399"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11925 Southwest Fwy Unit 3B",
            "address_purpose": "LOCATION",
            "city": "Stafford",
            "state": "TX",
            "postal_code": "774772300",
            "country_code": "US",
            "telephone_number": "832-460-5121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETUKNWA",
        "first_name": "MABEL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-09",
        "last_updated": "2021-07-23",
        "certification_date": "2021-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "TX",
            "license": "1-21-51371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in East Brunswick, NJ
• Providers in East Brunswick, NJ by specialty
• Behavior Analyst in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 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.