Provider Demographics
NPI:1508111873
Name:DICKES, NITASHA RAE (BCBA, PLMHP)
Entity Type:Individual
Prefix:
First Name:NITASHA
Middle Name:RAE
Last Name:DICKES
Suffix:
Gender:F
Credentials:BCBA, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 18TH ST APT 2L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-6114
Mailing Address - Country:US
Mailing Address - Phone:402-490-6983
Mailing Address - Fax:
Practice Address - Street 1:329 18TH ST APT 2L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6114
Practice Address - Country:US
Practice Address - Phone:402-490-6983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9649101YM0800X
NY000509103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025287200Medicaid