Provider Demographics
NPI:1407330020
Name:NUNN, OLIVIA NICOLE (BCBA)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:NICOLE
Last Name:NUNN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:NICOLE
Other - Last Name:ART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:PO BOX 784022
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-4022
Mailing Address - Country:US
Mailing Address - Phone:513-847-4685
Mailing Address - Fax:
Practice Address - Street 1:7413 SQUIRE CT
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2313
Practice Address - Country:US
Practice Address - Phone:513-847-4685
Practice Address - Fax:513-847-4763
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
OHCOBA.00835103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0315881Medicaid