Active NPI
Thomas Jernagen Widger, M.A., BCBA
- Behavior Analyst
- Oakland, CA
National Provider Identifier
1851615785
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1031464
- Practice address
- 477 41St St
Apt. a
Oakland, CA 94609 - Phone
- (510) 290-6732
- Fax
- (510) 735-9725
- NPI assigned
- Mar 22, 2010
- Sex
- Male
- 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 Analyst | 103K00000X | 1031464 | CA | Primary |
Addresses
Primary practice location
477 41St St
Apt. a
Oakland, CA 94609
Mailing address
477 41St St
Apt. a
Oakland, CA 94609
Phone (510) 290-6732
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1031464 | CA | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1269216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1269216000000",
"number": "1851615785",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "477 41ST ST",
"address_2": "APT. A",
"city": "OAKLAND",
"state": "CA",
"postal_code": "94609",
"telephone_number": "510-290-6732",
"fax_number": "510-735-9725"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "477 41ST ST",
"address_2": "APT. A",
"city": "OAKLAND",
"state": "CA",
"postal_code": "94609",
"telephone_number": "510-290-6732",
"fax_number": "510-735-9725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIDGER",
"first_name": "THOMAS",
"middle_name": "JERNAGEN",
"name_prefix": "Mr.",
"credential": "M.A., BCBA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-03-22",
"last_updated": "2010-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": "1031464",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.