Provider Demographics
NPI:1659791416
Name:FABRE-NELSON, NICOLE (MS, BSL)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:FABRE-NELSON
Suffix:
Gender:F
Credentials:MS, BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 CEDARCREST RD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-1437
Mailing Address - Country:US
Mailing Address - Phone:267-688-4324
Mailing Address - Fax:
Practice Address - Street 1:10541 DRUMMOND RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-3807
Practice Address - Country:US
Practice Address - Phone:215-612-7625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000119103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst