Active NPI
Demitrius Wall
- Behavior Analyst
- Chicopee, MA
National Provider Identifier
1922849777
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 10 Center St
Chicopee, MA 01013-2680 - Phone
- (413) 540-1234
- Fax
- (413) 538-5169
- NPI assigned
- Jun 5, 2024
- 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 | MA | Primary |
Addresses
Primary practice location
10 Center St
Chicopee, MA 01013-2680
Mailing address
10 Center St
Chicopee, MA 01013-2680
Phone (413) 540-1234
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| River Valley Counseling Center, Inc | Current | Accepting new patients | |
| Rise Behavioral Health Services | Past | Accepting new patients |
Locations
10 Center St
Chicopee, MA 01013
Phone (413) 437-9200
Organizations & group practices 2
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Holyoke, MA
- NPI 1851444616
-
- In Home Supportive Care Agency
- West Springfield, MA
- NPI 1316590979
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1717545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726531200000",
"number": "1922849777",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 CENTER ST",
"city": "CHICOPEE",
"state": "MA",
"postal_code": "010132680",
"telephone_number": "413-540-1234",
"fax_number": "134-538-5169"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 CENTER ST",
"city": "CHICOPEE",
"state": "MA",
"postal_code": "010132680",
"telephone_number": "413-540-1234",
"fax_number": "413-538-5169"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALL",
"first_name": "DEMITRIUS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-06-05",
"last_updated": "2024-09-17",
"certification_date": "2024-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicopee, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.