Provider Demographics
NPI:1528567229
Name:LOBIONDO, NICHOLAS (BCABA)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:LOBIONDO
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 FORDS POINTE CIR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-8118
Mailing Address - Country:US
Mailing Address - Phone:848-333-7336
Mailing Address - Fax:
Practice Address - Street 1:107 SOUTHERN BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-7441
Practice Address - Country:US
Practice Address - Phone:800-844-1232
Practice Address - Fax:848-844-1232
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
GA0-21-12068106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst