Healthcare Provider Details

I. General information

NPI: 1639083025
Provider Name (Legal Business Name): JOCELYN CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 INVENTA PL STE 200W
SILVER SPRING MD
20910-5171
US

IV. Provider business mailing address

4512 14TH ST NW
WASHINGTON DC
20011-4359
US

V. Phone/Fax

Practice location:
  • Phone: 240-502-3024
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2846227
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: