Provider Demographics
NPI:1083817357
Name:NIEDERMAYER, VICKI LYNN (BCBA)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:NIEDERMAYER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:LYNN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:5801 GLOUCESTER CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-2384
Mailing Address - Country:US
Mailing Address - Phone:817-690-7218
Mailing Address - Fax:
Practice Address - Street 1:5801 GLOUCESTER CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-2384
Practice Address - Country:US
Practice Address - Phone:817-690-7218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-07-3381103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1-07-3381OtherBOARD CERT. BEH.ANALYST