Provider Demographics
NPI:1518308824
Name:SCHROEER, NICOLE (BCBA)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:SCHROEER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-9759
Mailing Address - Country:US
Mailing Address - Phone:718-812-6124
Mailing Address - Fax:
Practice Address - Street 1:300 CLAREMONT LN STE 103
Practice Address - Street 2:
Practice Address - City:CROZET
Practice Address - State:VA
Practice Address - Zip Code:22932-3455
Practice Address - Country:US
Practice Address - Phone:434-466-1588
Practice Address - Fax:866-289-5249
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000285103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0133000285OtherSTATE LICENSING BOARD