Provider Demographics
NPI:1023781085
Name:ROONEY, NICOLE RENE (LBS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENE
Last Name:ROONEY
Suffix:
Gender:F
Credentials:LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7732 SCENIC VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-2091
Mailing Address - Country:US
Mailing Address - Phone:484-294-7176
Mailing Address - Fax:
Practice Address - Street 1:1247 S CEDAR CREST BLVD STE 107
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6347
Practice Address - Country:US
Practice Address - Phone:610-770-1800
Practice Address - Fax:610-770-1805
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH005457103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst