Provider Demographics
NPI:1740621820
Name:BOLLENBACH, NICOLE (MA, BCBA)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:BOLLENBACH
Suffix:
Gender:F
Credentials:MA, 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 RACHEL CT
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08809-1382
Mailing Address - Country:US
Mailing Address - Phone:908-505-5458
Mailing Address - Fax:
Practice Address - Street 1:9 RACHEL CT
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-1382
Practice Address - Country:US
Practice Address - Phone:908-505-5458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-13-13021103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst