Active NPI
Jisell Maria Jimenez
- Behavior Technician
- Cromwell, CT
National Provider Identifier
1861917411
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 21906528
- Practice address
- 162 West St Ste F
Cromwell, CT 06416-4405 - Phone
- (860) 613-9930
- NPI assigned
- Aug 4, 2017
- Last updated
- Aug 4, 2017
- 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 | 21906528 | CT | Primary |
Addresses
Primary practice location
162 West St Ste F
Cromwell, CT 06416-4405
Mailing address
42 Village Wood Dr Apt 3
Waterbury, CT 06705-5734
Phone (203) 568-5341
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 |
|---|---|---|---|
| 21906528 | CT | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501804800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1501804800000",
"number": "1861917411",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "42 VILLAGE WOOD DR APT 3",
"city": "WATERBURY",
"state": "CT",
"postal_code": "067055734",
"telephone_number": "203-568-5341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "162 WEST ST STE F",
"city": "CROMWELL",
"state": "CT",
"postal_code": "064164405",
"telephone_number": "860-613-9930"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JIMENEZ",
"first_name": "JISELL",
"middle_name": "MARIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-04",
"last_updated": "2017-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CT",
"license": "21906528",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cromwell, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.