Provider Demographics
NPI:1457159246
Name:PROZZO, NICOLE ANNE (BCBA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANNE
Last Name:PROZZO
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 ZILINSKI DR
Mailing Address - Street 2:
Mailing Address - City:BELFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07718-1591
Mailing Address - Country:US
Mailing Address - Phone:908-770-8636
Mailing Address - Fax:
Practice Address - Street 1:301 ZILINSKI DR
Practice Address - Street 2:
Practice Address - City:BELFORD
Practice Address - State:NJ
Practice Address - Zip Code:07718-1591
Practice Address - Country:US
Practice Address - Phone:908-770-8636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-19-37848103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst