JESSICA DAMYANTI MAHABALI (NPI# 1811547086) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811547086 |
| Entity Type | Individual |
| Full Name | JESSICA DAMYANTI MAHABALI |
| Practice Address |
39210 State St Ste 220 Fremont CA 94538-1456 |
| Mailing Address |
7654 Linden Ct Newark CA 94560-2238 |
| Practice Telephone | 5108944135 |
| Mailing Telephone | 5105165016 |
| Enumeration Date | 2019-09-18 |
| Last Update Date | 2019-09-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106S00000X | Behavior Technician | 461305562 | CA | Behavioral Health & Social Service Providers |
| Street Address |
39210 STATE ST STE 220 |
| City | FREMONT |
| State | CA |
| Zip Code | 94538-1456 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407351521 | Melissa Fisher | Marriage & Family Therapist | 39210 State St Ste 220, Fremont, CA 94538-1456 | 2018-03-29 |
| 1356942874 | Amanda Huang Le | Behavior Technician | 39210 State St Ste 220, Fremont, CA 94538-1456 | 2020-11-02 |
| 1710588272 | Karen Ashley Bryant | Behavior Technician | 39210 State St Ste 220, Fremont, CA 94538-1456 | 2020-11-02 |
| 1487251856 | Jamie Leigh Emery | Behavior Technician | 39210 State St Ste 220, Fremont, CA 94538-1456 | 2020-10-07 |
| 1164029773 | Gurpriya K Bhela | Behavior Technician | 39210 State St Ste 220, Fremont, CA 94538-1456 | 2020-10-06 |
| 1225644156 | Caitlin Marie Benge | Behavior Technician | 39210 State St Ste 220, Fremont, CA 94538-1456 | 2020-09-16 |
| 1811503782 | Britney Lien | Behavior Technician | 39210 State St Ste 220, Fremont, CA 94538-1456 | 2020-09-16 |
| 1255942199 | Madison Ann Romero | Behavior Technician | 39210 State St Ste 220, Fremont, CA 94538-1456 | 2020-08-13 |
| 1699386052 | Irene Mendez Ortega | Behavior Technician | 39210 State St Ste 220, Fremont, CA 94538-1456 | 2020-08-11 |
| 1538784582 | Rebecca Ascenso | Behavior Technician | 39210 State St Ste 220, Fremont, CA 94538-1456 | 2020-06-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699394460 | Bay Area Kidney Care Medical Group Inc. | Clinic/Center | 39370 Mozart Terrace Unit 106, Fremont, CA 94538 | 2020-04-13 |
| 1740847284 | Gloria Ann Federico | Behavior Technician | 39210 State St., Suite 220 Fremont, Ca 94538, Fremont, CA 94538 | 2019-05-21 |
| 1093270688 | Timothy Lorne Haynes | Chiropractor | 3775 Beacon Ave., Suite 200, Fremont, CA 94538 | 2019-02-07 |
| 1902370067 | Nicole Sandoval | Counselor | 39155 Liberty St Suite E500, Fremont, CA 94538 | 2019-01-11 |
| 1497225015 | Megan Galban | Behavior Technician | 39210 State St. Suite 220, Fremont, CA 94538 | 2018-11-27 |
| 1780154302 | Karla Patricia Plascencia | Behavior Technician | 39210 State Street Suite 220, Fremont, CA 94538 | 2018-11-27 |
| 1215407846 | Sydney J Torrens | Behavior Technician | 39210 State St. Suite 220 Fremont, Ca 94538, Fremont, CA 94538 | 2018-11-27 |
| 1932676277 | Jarah Harvan | Psychologist | 1999 Mowry Ave Ste F, Fremont, CA 94538 | 2018-10-24 |
| 1205321965 | Chien Shien Yang Md Inc | Psychiatry & Neurology | 1860 Mowry Ave Ste 301a, Fremont, CA 94538 | 2018-06-26 |
| 1912416199 | Advanced Interventional Surgical Center | Clinic/Center | 3077 Stevenson Blvd, Fremont, CA 94538 | 2017-09-20 |
| Find all providers in zip 94538 | ||||
| Taxonomy Code | 106S00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Behavior Technician |
| The behavior technician is a paraprofessional who practices under the close, ongoing supervision of a behavior analyst or assistant behavior analyst certified by the Behavior Analyst Certification Board and/or credentialed by a state (such as through licensure). The behavior technician is primarily responsible for the implementation of components of behavior-analytic treatment plans developed by the supervisor. That may include collecting data on treatment targets and conducting certain types of behavioral assessments (e.g., stimulus preference assessments). The behavior technician does not design treatment or assessment plans or procedures but provides services as assigned by the supervisor responsible for his or her work. |
| 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 |
|---|---|---|---|---|
| 1225639057 | Rebecca Quinones | Behavior Technician | 4434 Kennett Ter, Fremont, CA 94536-5735 | 2020-11-06 |
| 1013516715 | Kearndeep Kaur | Behavior Technician | 34769 Comstock Cmn, Fremont, CA 94555-2819 | 2020-10-22 |
| 1689289548 | Ina Gonzalez | Behavior Technician | 39210 State St Ste 204, Fremont, CA 94538-1456 | 2020-09-08 |
| 1184238420 | Samantha Padilla | Behavior Technician | 39201i State St, Fremont, CA 94538-1437 | 2020-09-03 |
| 1215556238 | Rochelle Anne Dizon Rufo | Behavior Technician | 4593 Hansen Ave, Fremont, CA 94536-5767 | 2020-04-09 |
| 1346874419 | Tiffany Lillian Chen | Behavior Technician | 43231 Fresco Ter, Fremont, CA 94539-5885 | 2020-02-27 |
| 1417589888 | Alicia Luna | Behavior Technician | 3340 Walnut Ave Ste 290, Fremont, CA 94538-2215 | 2020-02-04 |
| 1447890256 | Nicolas Yoshio Jimenez | Behavior Technician | 1133 Auburn St Ste 20, Fremont, CA 94538-7329 | 2020-01-09 |
| 1902444953 | Jasnoor Kaur | Behavior Technician | 4128 Fairwood St, Fremont, CA 94538-6013 | 2019-12-19 |
| 1891333951 | Humaiza Naveed | Behavior Technician | 4737 Thornton Ave, Fremont, CA 94536-6462 | 2019-12-19 |
| Find all providers in FREMONT | ||||
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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.