Provider Demographics
NPI:1689093411
Name:PHIAMBOLIS, NICHOLE ALEXANDRA (MS, BCBA, BSL)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:ALEXANDRA
Last Name:PHIAMBOLIS
Suffix:
Gender:F
Credentials:MS, BCBA, BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3614 ORCHARD CT
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-2842
Mailing Address - Country:US
Mailing Address - Phone:215-840-4708
Mailing Address - Fax:
Practice Address - Street 1:3614 ORCHARD CT
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-2842
Practice Address - Country:US
Practice Address - Phone:215-840-4708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000253103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst