Provider Demographics
NPI:1497204697
Name:GEND, NICOLE (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:GEND
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23030 LYONS AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2752
Mailing Address - Country:US
Mailing Address - Phone:661-425-7066
Mailing Address - Fax:805-299-4505
Practice Address - Street 1:23030 LYONS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2752
Practice Address - Country:US
Practice Address - Phone:661-425-7066
Practice Address - Fax:805-299-4505
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-23745103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-16-23745OtherBCBA