Provider Demographics
NPI:1578236808
Name:CRIPPS, NICOLE M (BCBA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:CRIPPS
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 1:780 NEWTOWN YARDLEY RD STE 322
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-4502
Mailing Address - Country:US
Mailing Address - Phone:215-704-9224
Mailing Address - Fax:
Practice Address - Street 1:780 NEWTOWN YARDLEY RD STE 322
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-4502
Practice Address - Country:US
Practice Address - Phone:215-704-9224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARBT-21-178135106S00000X
PA1-23-66607103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician