Provider Demographics
NPI:1942709407
Name:BURNS, NICHOLAS JOSEPH (MA LBS BCBA)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JOSEPH
Last Name:BURNS
Suffix:
Gender:M
Credentials:MA LBS BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 S GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-3333
Mailing Address - Country:US
Mailing Address - Phone:412-726-3604
Mailing Address - Fax:
Practice Address - Street 1:199 S GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-3333
Practice Address - Country:US
Practice Address - Phone:412-726-3604
Practice Address - Fax:412-726-3604
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-14-15866103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst