Provider Demographics
NPI:1205500618
Name:TURSENOVIC, NICOLLE ANESA (MS, BCBA)
Entity type:Individual
Prefix:
First Name:NICOLLE
Middle Name:ANESA
Last Name:TURSENOVIC
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HILL CT
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-2363
Mailing Address - Country:US
Mailing Address - Phone:718-216-6563
Mailing Address - Fax:
Practice Address - Street 1:9 HILL CT
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-2363
Practice Address - Country:US
Practice Address - Phone:718-216-6563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-21-50203103K00000X
CA210068940103TS0200X
NY002138103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool