Provider Demographics
NPI:1164928222
Name:HOCKENBERRY, NICOLE (BCBA, LBS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:HOCKENBERRY
Suffix:
Gender:F
Credentials:BCBA, LBS
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:KITZMILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:325 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WORMLEYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1104
Mailing Address - Country:US
Mailing Address - Phone:844-588-4222
Mailing Address - Fax:717-775-3443
Practice Address - Street 1:325 N 2ND ST
Practice Address - Street 2:
Practice Address - City:WORMLEYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17043-1104
Practice Address - Country:US
Practice Address - Phone:844-588-4222
Practice Address - Fax:717-775-3443
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARBT-18-52367106S00000X
PABH004983103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician