Provider Demographics
NPI:1942972377
Name:WHITTLESEY, NIKOLA JAMES
Entity Type:Individual
Prefix:
First Name:NIKOLA
Middle Name:JAMES
Last Name:WHITTLESEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 MAIN ST APT A310
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-2470
Mailing Address - Country:US
Mailing Address - Phone:978-590-3179
Mailing Address - Fax:
Practice Address - Street 1:6 LINCOLN KNOLL LN STE 104
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4729
Practice Address - Country:US
Practice Address - Phone:818-241-6780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician