Provider Demographics
NPI:1770229049
Name:CRANE, NICHOLE (BCBA)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:CRANE
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 1:560 SYLVAN AVE STE 2048
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-3165
Mailing Address - Country:US
Mailing Address - Phone:646-857-6600
Mailing Address - Fax:646-859-4440
Practice Address - Street 1:9005 OVERLOOK BLVD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5269
Practice Address - Country:US
Practice Address - Phone:615-733-4651
Practice Address - Fax:646-859-4440
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-21-56576103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst