Active NPI
Dominique Mannerino
- Behavior Analyst
- Madison, WI
National Provider Identifier
1992450019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 3113 W Beltline Hwy
Madison, WI 53713-2848 - Phone
- (608) 819-6810
- NPI assigned
- Feb 17, 2022
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-22-203703 | FL | |
| Behavior Analyst | 103K00000X | Primary |
Addresses
Primary practice location
3113 W Beltline Hwy
Madison, WI 53713-2848
Mailing address
6225 Smith Ave Ste 1001a
Baltimore, MD 21209-3626
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 |
|---|---|---|---|
| RBT-22-203703 | FL | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| KGH Consultation & Treatment, Inc. | Behavior Analyst | 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.
-
- Behavior Analyst
- Deerfield, IL
- NPI 1073840740
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1645056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1764720000000",
"number": "1992450019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6225 SMITH AVE STE 1001A",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212093626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3113 W BELTLINE HWY",
"city": "MADISON",
"state": "WI",
"postal_code": "537132848",
"telephone_number": "608-819-6810"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANNERINO",
"first_name": "DOMINIQUE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-02-17",
"last_updated": "2025-12-03",
"certification_date": "2025-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "RBT-22-203703",
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.