KEITH JACKMAN (NPI# 1841737152) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841737152 |
| Entity Type | Individual |
| Full Name | KEITH JACKMAN |
| Practice Address |
880 Vantage St Se Palm Bay FL 32909-4947 |
| Practice Telephone | 3212920243 |
| Mailing Telephone | 3212920243 |
| Enumeration Date | 2017-01-24 |
| Last Update Date | 2017-01-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106S00000X | Behavior Technician | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 656410 | 05 |
| Street Address |
880 VANTAGE ST SE |
| City | PALM BAY |
| State | FL |
| Zip Code | 32909-4947 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205447349 | Sarah Nicosia | Registered Nurse | 2752 Palisades Dr, Palm Bay, FL 32909 | 2020-08-12 |
| 1447881297 | Shangri-la of Palm Bay Alf, LLC | Assisted Living Facility | 3604 Jupiter Blvd. Se, Palm Bay, FL 32909 | 2020-01-30 |
| 1972094357 | Mindful Counseling and Wellness LLC | Social Worker | 221 Devlin Ct Se, Palm Bay, FL 32909 | 2018-05-22 |
| 1306348859 | Mallory Kathleen Herndon | Behavior Technician | 458 Barcelona Rd, Palm Bay, FL 32909 | 2018-03-01 |
| 1548786627 | Chotsani Merrill | Home Health Aide | 781 Davenport St Se, Palm Bay, FL 32909 | 2017-08-21 |
| 1639629538 | Maggie Cameron | Clinic/Center | 2511 Quentin Ave Ne, Palm Bay, FL 32909 | 2016-10-04 |
| 1194195016 | Dawn Goodwin | Pharmacist | 3450 Bayside Lakes Shopping Center, Palm Bay, FL 32909 | 2015-10-05 |
| 1124407796 | Jorge Ortiz | Physical Therapist | 470 Malabar Rd Se, Ste 102, Palm Bay, FL 32909 | 2015-05-28 |
| 1932506227 | Annalisa Tietjen I | Dental Hygienist | 714 Ave C, Fort Pierce, FL 32909 | 2014-12-02 |
| 1194147611 | Carl Glenmore Morrison Sr. | General Practice | 2125 Windbrook Drive, Palm Bay, FL 32909 | 2014-01-17 |
| Find all providers in zip 32909 | ||||
| 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 |
|---|---|---|---|---|
| 1023633245 | Tracy Lee Curtis | Behavior Technician | 1690 Walker St Se, Palm Bay, FL 32909-5978 | 2020-06-12 |
| 1861015109 | Tyreak Albert Mclarty | Behavior Technician | 2180 Julian Ave Nw, Palm Bay, FL 32907 | 2020-05-21 |
| 1144841610 | Penelope Rivera | Behavior Technician | 1010 Abada Ct Ne Apt 101, Palm Bay, FL 32905-3709 | 2020-05-06 |
| 1871133009 | Maya Williams | Behavior Technician | 2695 Raven Ave Se, Palm Bay, FL 32909-7210 | 2020-01-15 |
| 1376180208 | Michael Leonard James II | Behavior Technician | 1512 Harvard Cir Apt 5, Palm Bay, FL 32905-2248 | 2019-12-10 |
| 1619539178 | Leidy Almira | Behavior Technician | 825 Sorrel St Nw, Palm Bay, FL 32907-1754 | 2019-07-05 |
| 1730743592 | Audra Lloy Forbes | Behavior Technician | 251 District St Se, Palm Bay, FL 32909-4786 | 2019-04-26 |
| 1306348859 | Mallory Kathleen Herndon | Behavior Technician | 458 Barcelona Rd, Palm Bay, FL 32909 | 2018-03-01 |
| 1467969246 | Stacey Juliano | Behavior Technician | 1610 Santos St Se Apt B, Palm Bay, FL 32909-6342 | 2018-01-03 |
| 1194236711 | Roxanne Ross | Behavior Technician | 1261 Goode Dr Ne, Palm Bay, FL 32907-1148 | 2017-10-23 |
| Find all providers in PALM BAY | ||||
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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.