Provider Demographics
NPI:1770003188
Name:POTTS, NICHOLAS (BCBA)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:POTTS
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SAUNDERS WAY STE 900
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4836
Mailing Address - Country:US
Mailing Address - Phone:207-878-9663
Mailing Address - Fax:
Practice Address - Street 1:15 SAUNDERS WAY STE 900
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4836
Practice Address - Country:US
Practice Address - Phone:207-878-9663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-26459103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-17-26459OtherBCBA CERTIFICATION