JEREMIAH ROSS (NPI# 1639593502) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639593502 |
| Entity Type | Individual |
| Full Name | JEREMIAH ROSS |
| Practice Address |
4647 Clyde Morris Blvd Unit 501 Port Orange FL 32129-3001 |
| Practice Telephone | 3867673752 |
| Practice Fax Number | 7726759100 |
| Mailing Telephone | 3867673752 |
| Mailing Fax Number | 7726759100 |
| Enumeration Date | 2014-02-12 |
| Last Update Date | 2019-05-27 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106E00000X | Assistant Behavior Analyst | Behavioral Health & Social Service Providers |
| Street Address |
4647 CLYDE MORRIS BLVD UNIT 501 |
| City | PORT ORANGE |
| State | FL |
| Zip Code | 32129-3001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265031298 | Tracy A Smith | Behavior Technician | 4647 Clyde Morris Blvd Unit 501, Port Orange, FL 32129-3001 | 2020-10-21 |
| 1902412224 | Esther Drumheller Hetzel | Behavior Technician | 4647 Clyde Morris Blvd Unit 501, Port Orange, FL 32129-3001 | 2020-09-22 |
| 1588270532 | Kristi Susann Pace | Behavior Technician | 4647 Clyde Morris Blvd Unit 501, Port Orange, FL 32129-3001 | 2020-09-16 |
| 1932727757 | Michaela Riane Cummo | Behavior Technician | 4647 Clyde Morris Blvd Unit 501, Port Orange, FL 32129-3001 | 2020-07-08 |
| 1740805480 | Kayla Rogers | Behavior Technician | 4647 Clyde Morris Blvd Unit 501, Port Orange, FL 32129-3001 | 2020-06-09 |
| 1134743909 | Chimsomaga Vivian Ozuzu | Behavior Technician | 4647 Clyde Morris Blvd Unit 501, Port Orange, FL 32129-3001 | 2020-06-07 |
| 1154943124 | Brandie Nicole Scheu | Behavior Technician | 4647 Clyde Morris Blvd Unit 501, Port Orange, FL 32129-3001 | 2020-05-13 |
| 1912553777 | Zalika A Freeman | Behavior Technician | 4647 Clyde Morris Blvd Unit 501, Port Orange, FL 32129-3001 | 2019-08-16 |
| 1164076576 | Lakesha Jones | Behavior Technician | 4647 Clyde Morris Blvd Unit 501, Port Orange, FL 32129-3001 | 2019-07-25 |
| 1881256444 | Andrea Williams | Behavior Technician | 4647 Clyde Morris Blvd Unit 501, Port Orange, FL 32129-3001 | 2019-07-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982179818 | Port Orange Modern Dentistry, Pa | Dentist | 1765 Dunlawton Ave., Suite 103, Port Orange, FL 32129 | 2018-10-08 |
| 1932698131 | Brittany Michele Claude | Behavioral Analyst | 4647 Clyde Morris Blvd Suite 501, Port Orange, FL 32129 | 2018-05-03 |
| 1760919468 | Makayla Earl | Behavior Technician | 1557 Town Park Dr., Port Orange, FL 32129 | 2017-05-12 |
| 1184157968 | Katie Lynn Weisz | Physician Assistant | 3635 South Clyde Morris Blvd, Suite 100, Port Orage, FL 32129 | 2017-04-07 |
| 1285178319 | Mallory Driggers | Counselor | 980 Canal View Blvd Apt F7, Port Orange, FL 32129 | 2016-12-08 |
| 1912321654 | Edward L. Staudt Dds & Kenneth L. Staudt Dds, Mph | Dentist | 944 Bridgewater Dr., Suite 2-b, Port Orange, FL 32129 | 2014-02-18 |
| 1538411731 | Roberta Ann Gilmartin | Specialist | 1048 W Samms Ave, Port Orange, FL 32129 | 2012-10-11 |
| 1679892996 | Pamela Kirby Pa | Clinic/Center | 4606 South Clyde Morris Boulevard, Suite 1j, Port Orange, FL 32129 | 2010-05-26 |
| 1326376385 | Connie Jeanne Bodnarik | Physical Therapy Assistant | 3780 S Clyde Morris Blvd Apt 1206, Port Orange, FL 32129 | 2009-12-02 |
| 1669645057 | American Family & Sports Chiropractic Center Inc | Chiropractor | 4649 Clyde Morris Blvd Unit 609, Port Orange, FL 32129 | 2008-04-08 |
| Find all providers in zip 32129 | ||||
| Taxonomy Code | 106E00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Assistant Behavior Analyst |
| An assistant behavior analyst is qualified by Behavior Analyst Certification Board certification and/or a state-issued license or credential in behavior analysis to practice under the supervision of an appropriately credentialed professional behavior analyst. An assistant behavior analyst delivers services consistent with the dimensions of applied behavior analysis and supervision requirements defined in state laws or regulations and/or national certification standards. Common services may include, but are not limited to, conducting behavioral assessments, analyzing data, writing behavior-analytic treatment plans, training and supervising others in implementation of components of treatment plans, and direct implementation of treatment plans. |
| Notes: Association of Professional Behavior Analysts, www.apbahome.net and Behavior Analyst Certification Board (http://www.bacb.com) [7/1/2016: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184138190 | Kathryn Boehm | Assistant Behavior Analyst | 644 Hamlet Dr, Port Orange, FL 32127-5986 | 2017-11-29 |
| 1407386709 | Dwayne Thomas Thiels | Assistant Behavior Analyst | 829 Angelina Ct, Port Orange, FL 32127-5378 | 2017-06-19 |
| 1689137390 | Caitlyn Coyne | Assistant Behavior Analyst | 4647 Clyde Morris Blvd Unit 501, Port Orange, FL 32129-3001 | 2019-04-09 |
| 1639681406 | Bradley Buckelew | Assistant Behavior Analyst | 823 Dunlawton Ave, Port Orange, FL 32127-4220 | 2017-11-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992305924 | Irialis Gonzalez Gutierrez | Assistant Behavior Analyst | 6261 W Flagler St Apt 22, Miami, FL 33144-3024 | 2020-10-28 |
| 1265031157 | Raquel Daetz Garcia | Assistant Behavior Analyst | 11262 Sw 230th Ter, Miami, FL 33170-7612 | 2020-10-21 |
| 1790383149 | Jorge L Hernandez Aguilar | Assistant Behavior Analyst | 14236 Sw 91st St, Miami, FL 33186-7802 | 2020-10-16 |
| 1114525839 | Stepping Stones Supports LLC | Assistant Behavior Analyst | 5221 Nw 81st Ter, Lauderhill, FL 33351-5050 | 2020-10-14 |
| 1912505884 | Maria Matilde Alonso Urquijo | Assistant Behavior Analyst | 7317 Sw 22nd St, Miami, FL 33155-1426 | 2020-10-13 |
| 1093312647 | Rody Blanco | Assistant Behavior Analyst | 18512 Field Club Way, Tampa, FL 33647-1823 | 2020-10-07 |
| 1699372870 | Karen Zhao | Assistant Behavior Analyst | 8303 Sw 107th Ave Apt A, Miami, FL 33173-3805 | 2020-10-01 |
| 1508473802 | Camryn Nichole White | Assistant Behavior Analyst | 301 South Florida Ave, Lakeland, FL 33801 | 2020-09-30 |
| 1689281453 | Betsy Escobar Lozada | Assistant Behavior Analyst | 601 Ludlam Dr Apt 1, Miami Springs, FL 33166-4971 | 2020-09-25 |
| 1710593991 | Odalis De Las Mercedes Marrero | Assistant Behavior Analyst | 6502 Blue Ribbon Ln Apt 301, Tampa, FL 33625-2480 | 2020-09-22 |
| Find all providers with the same taxonomy | ||||
| City | PORT ORANGE |
| Zip Code | 32129 |
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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.