Provider Demographics
NPI:1083062236
Name:NICHOLASI, ANTOINETTE (BCBA)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:NICHOLASI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ANTOINETTE
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:5 N LONGVIEW RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-1701
Mailing Address - Country:US
Mailing Address - Phone:917-885-3296
Mailing Address - Fax:
Practice Address - Street 1:5 N LONGVIEW RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-1701
Practice Address - Country:US
Practice Address - Phone:917-885-3296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-15-18870103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst