Provider Demographics
NPI:1073928339
Name:FELL, NICOLE (MS, BCBA)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:FELL
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:LAPAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:160 RIVERSIDE BLVD APT 14T
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10069-0709
Mailing Address - Country:US
Mailing Address - Phone:781-354-6531
Mailing Address - Fax:
Practice Address - Street 1:777 PARAMUS RD
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1710
Practice Address - Country:US
Practice Address - Phone:201-612-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-17-27950103K00000X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist