Provider Demographics
NPI:1821759879
Name:PAVLIN, NICOLE (BCBA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:PAVLIN
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 1:797 WARWICK TPKE
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:NJ
Mailing Address - Zip Code:07421-1757
Mailing Address - Country:US
Mailing Address - Phone:201-306-2666
Mailing Address - Fax:
Practice Address - Street 1:240 LONGHOUSE DR
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:NJ
Practice Address - Zip Code:07421-3730
Practice Address - Country:US
Practice Address - Phone:201-306-2666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-21-52328103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst