Provider Demographics
NPI:1598129843
Name:BEATRICE, NIKKI DANIELLE
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:DANIELLE
Last Name:BEATRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 CAMBRIDGE STREET
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-2445
Mailing Address - Country:US
Mailing Address - Phone:860-608-3229
Mailing Address - Fax:
Practice Address - Street 1:524 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-2445
Practice Address - Country:US
Practice Address - Phone:860-608-3229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst