Provider Demographics
NPI:1093298564
Name:NICOLE VENDETTE, LLC
Entity Type:Organization
Organization Name:NICOLE VENDETTE, LLC
Other - Org Name:THE COLLABORATIVE BEHAVIOR GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:VENDETTE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:407-947-4675
Mailing Address - Street 1:3344 NE SANDRA DR
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-3972
Mailing Address - Country:US
Mailing Address - Phone:407-947-4675
Mailing Address - Fax:
Practice Address - Street 1:10272 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5615
Practice Address - Country:US
Practice Address - Phone:407-947-4675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-11
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health