Provider Demographics
NPI:1508517863
Name:SCOTTO, NICOLE BRIANNA (MS, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:BRIANNA
Last Name:SCOTTO
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BETSY ROSS CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-4612
Mailing Address - Country:US
Mailing Address - Phone:631-672-0441
Mailing Address - Fax:
Practice Address - Street 1:7 BETSY ROSS CT
Practice Address - Street 2:
Practice Address - City:SOUTH SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720-4612
Practice Address - Country:US
Practice Address - Phone:631-672-0441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002248103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst