Active NPI
Jessica Lyn Mangan, BCBA
- Behavior Analyst
- Woburn, MA
National Provider Identifier
1902579709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 39158
- Practice address
- 100 Sylvan Rd Ste G700
Woburn, MA 01801-1817 - Phone
- (781) 569-5111
- Fax
- (781) 569-5112
- NPI assigned
- Jul 28, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 | 39158 | MA | Primary |
Addresses
Primary practice location
100 Sylvan Rd Ste G700
Woburn, MA 01801-1817
Mailing address
30 Rich St Apt 23
Malden, MA 02148-7844
Phone (617) 833-2886
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39158 | Other | MA | LICENSE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | info@likeaphoenix.com |
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 |
|---|---|---|---|
| 39158 | MA | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jeanom LLC | Single Specialty | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1627430400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627430400000",
"number": "1902579709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 RICH ST APT 23",
"city": "MALDEN",
"state": "MA",
"postal_code": "021487844",
"telephone_number": "617-833-2886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 SYLVAN RD STE G700",
"city": "WOBURN",
"state": "MA",
"postal_code": "018011817",
"telephone_number": "781-569-5111",
"fax_number": "781-569-5112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANGAN",
"first_name": "JESSICA",
"middle_name": "LYN",
"name_prefix": "Ms.",
"credential": "BCBA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-07-28",
"last_updated": "2021-07-28",
"certification_date": "2021-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Behavior Analyst",
"state": "MA",
"license": "39158",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "39158",
"state": "MA"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "info@likeaphoenix.com",
"affiliation": "N",
"address_1": "100 Sylvan Rd Ste G700",
"city": "Woburn",
"state": "MA",
"country_code": "US",
"postal_code": "018011817",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Woburn, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 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.