Provider Demographics
NPI:1780070615
Name:NESICOLACI, REBECA (BCBA)
Entity type:Individual
Prefix:
First Name:REBECA
Middle Name:
Last Name:NESICOLACI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 SHADELANDS DR FL 2
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2538
Mailing Address - Country:US
Mailing Address - Phone:925-266-8400
Mailing Address - Fax:
Practice Address - Street 1:1910 OLYMPIC BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5096
Practice Address - Country:US
Practice Address - Phone:925-283-3073
Practice Address - Fax:925-283-3079
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-15-18141103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst