Provider Demographics
NPI:1134420615
Name:CONEBY, NICOLE (LSW, BCBA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CONEBY
Suffix:
Gender:F
Credentials:LSW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1143
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08542-1143
Mailing Address - Country:US
Mailing Address - Phone:800-675-2709
Mailing Address - Fax:800-675-2709
Practice Address - Street 1:118 KESWICK AVE
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-2836
Practice Address - Country:US
Practice Address - Phone:609-417-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-09-5611103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst