Provider Demographics
NPI:1851529903
Name:GOLDEN, NICHOLAS (PSYD, BCBA-D, LABA)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:M
Credentials:PSYD, BCBA-D, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:MA
Mailing Address - Zip Code:01834-2106
Mailing Address - Country:US
Mailing Address - Phone:508-509-5907
Mailing Address - Fax:
Practice Address - Street 1:6 SOUTHSIDE RD
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1409
Practice Address - Country:US
Practice Address - Phone:978-624-2340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 101YM0800X
MA590103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM20807OtherBLUE CROSS
MA1312677Medicaid
MA685661OtherTUFTS