Provider Demographics
NPI:1932514114
Name:PEARSON, NICOLE KATHLEEN (PSYD BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:KATHLEEN
Last Name:PEARSON
Suffix:
Gender:F
Credentials:PSYD BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 S LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-2523
Mailing Address - Country:US
Mailing Address - Phone:201-788-6619
Mailing Address - Fax:
Practice Address - Street 1:223 S LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-2523
Practice Address - Country:US
Practice Address - Phone:201-788-6619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001136103K00000X
NY1-12-12365103K00000X
NY020115103T00000X
CO0004775103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst