Provider Demographics
NPI:1275214330
Name:DIGRAZIA, NICOLE (BCBA LBA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:DIGRAZIA
Suffix:
Gender:F
Credentials:BCBA LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2791 BEATRICE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-2012
Mailing Address - Country:US
Mailing Address - Phone:516-477-9785
Mailing Address - Fax:
Practice Address - Street 1:2791 BEATRICE LN
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-2012
Practice Address - Country:US
Practice Address - Phone:516-477-9785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002411103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst