JERRY GEORGE IDICULA (NPI# 1356711766) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356711766 |
| Entity Type | Individual |
| Full Name | JERRY GEORGE IDICULA |
| Credential | M.ED., BCBA |
| Practice Address |
1332 Maryland St Grosse Pointe Park MI 48230 |
| Mailing Address |
1332 Maryland St Grosse Pointe Park MI 48230-1006 |
| Practice Telephone | 3132889458 |
| Mailing Telephone | 3132889458 |
| Enumeration Date | 2015-09-28 |
| Last Update Date | 2019-03-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103K00000X | Behavioral Analyst | 1-19-34854 | MI | Behavioral Health & Social Service Providers |
| Street Address |
1332 MARYLAND ST |
| City | GROSSE POINTE PARK |
| State | MI |
| Zip Code | 48230 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184195125 | Carlyle Center LLC | Behavioral Analyst | 1332 Maryland St, Grosse Pointe Park, MI 48230-1006 | 2018-12-17 |
| 1063923746 | Batoul Dekmak | Behavioral Analyst | 1332 Maryland St, Grosse Pointe Park, MI 48230-1006 | 2017-10-20 |
| 1598123556 | Carly Steiner | Behavioral Analyst | 1332 Maryland St, Grosse Pointe Park, MI 48230-1006 | 2016-02-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518573450 | Burd Home Health LLC | In Home Supportive Care | 15001 Kerchezal Ave Unit #2042, Grosse Point Park, MI 48230 | 2020-09-16 |
| 1962924886 | Michelle Kathleen Harr | Speech-Language Pathologist | 1356 Bishop Rd, Grosse Pointe Park, MI 48230 | 2017-07-12 |
| 1578939930 | Sierra Gray | Contractor | 890 Cadieux, Grosse Pointe, MI 48230 | 2015-08-19 |
| 1023413853 | Cristovao Bartolo Carreira | Psychologist | 15450 E. Jefferson, Suite 200, Grosse Pointe, MI 48230 | 2014-10-22 |
| 1215217005 | Nui Loa PC | Community/Behavioral Health | 502 Pemberton, Grosse Pointe Park, MI 48230 | 2011-08-24 |
| 1295041846 | Greg Washington LLC | Psychiatry & Neurology | 793 Harcourt, Grosse Pointe Park, MI 48230 | 2010-08-20 |
| 1649445867 | Philip Charles Hessburg | Ophthalmology | 15415 E Jefferson Street, Grosse Pointe Park, MI 48230 | 2008-04-29 |
| 1437289071 | John Boyd Krisel Jr. | Social Worker | 15200 E Jefferson, Suite 105, Grosse Pointe Park, MI 48230 | 2007-03-06 |
| 1346382819 | Robert James Sisler | Social Worker | 15200 East Jefferson, Suite 105, Grosse Pointe Park, MI 48230 | 2007-02-13 |
| 1457492761 | Debra E Evola | Physician Assistant | 131 Kercheval, Pierson Clinic, Grosse Pointe Farms, MI 48230 | 2007-02-09 |
| Find all providers in zip 48230 | ||||
| Taxonomy Code | 103K00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Behavioral Analyst |
| A behavior analyst is qualified by at least a master’s degree and Behavior Analyst Certification Board certification and/or a state-issued credential (such as a license) to practice behavior analysis independently. Behavior analysts provide the required supervision to assistant behavior analysts and behavior technicians. A behavior analyst delivers services consistent with the dimensions of applied behavior analysis. Common services may include, but are not limited to, conducting behavioral assessments, analyzing data, writing and revising behavior-analytic treatment plans, training others to implement components of treatment plans, and overseeing implementation of treatment plans. |
| Notes: Source: Association of Professional Behavior Analysts, www.apbahome.net and Behavior Analyst Certification Board (http://www.bacb.com) [7/1/2008: new, 1/1/2016: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598150583 | Rachel Enright | Behavioral Analyst | 1007 Beaconsfield Ave, Apt 3, Grosse Pointe Park, MI 48230-2017 | 2015-04-06 |
| 1184195125 | Carlyle Center LLC | Behavioral Analyst | 1332 Maryland St, Grosse Pointe Park, MI 48230-1006 | 2018-12-17 |
| 1063923746 | Batoul Dekmak | Behavioral Analyst | 1332 Maryland St, Grosse Pointe Park, MI 48230-1006 | 2017-10-20 |
| 1598123556 | Carly Steiner | Behavioral Analyst | 1332 Maryland St, Grosse Pointe Park, MI 48230-1006 | 2016-02-05 |
| 1235573502 | James Macon | Behavioral Analyst | 1415 Somerset Ave, Grosse Pointe Park, MI 48230-1032 | 2013-04-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255930905 | Fatima Alkassir Othman | Behavioral Analyst | 4164 Westover Dr, West Bloomfield, MI 48323-2867 | 2020-10-23 |
| 1659970572 | Budding Behavior Therapy | Behavioral Analyst | 33923 Ryan Rd, Sterling Heights, MI 48310-6304 | 2020-10-21 |
| 1033726229 | Proud Moments Aba of Michigan Pllc | Behavioral Analyst | 25129 Pierce St, Southfield, MI 48075-2019 | 2020-09-30 |
| 1366058141 | Michigan Learning Community, LLC | Behavioral Analyst | 2704 Radcliffe Ave, Ann Arbor, MI 48104-6544 | 2020-09-17 |
| 1184239279 | Roopa Singh | Behavioral Analyst | 10751 S Saginaw St Ste E, Grand Blanc, MI 48439-8169 | 2020-09-15 |
| 1467064691 | Kaitlyn Jewel Tuttle | Behavioral Analyst | 2535 Hagley Rd, Standish, MI 48658-9148 | 2020-08-19 |
| 1750999249 | Creating Brighter Futures | Behavioral Analyst | 4201 Varsity Drive, Ste. C, Ann Arbor, MI 48108 | 2020-07-21 |
| 1194333542 | Nation of Wonders Inclusive Education | Behavioral Analyst | 19211 Beech Daly Rd, Redford, MI 48240-1418 | 2020-07-21 |
| 1184242216 | Brittany O'grady | Behavioral Analyst | 2314 Helen Ave Ste 100, Portage, MI 49002-1684 | 2020-07-06 |
| 1669098588 | Kiernan Mae Doud | Behavioral Analyst | 2305 Hawthorn Dr Ste A, Mt Pleasant, MI 48858-1202 | 2020-06-17 |
| Find all providers with the same taxonomy | ||||
| City | GROSSE POINTE PARK |
| Zip Code | 48230 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.