Provider Demographics
NPI:1780128801
Name:GRILLE, NICOLE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:GRILLE
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 1:9711 HAMMOCKS BLVD APT 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1555
Mailing Address - Country:US
Mailing Address - Phone:786-537-1583
Mailing Address - Fax:
Practice Address - Street 1:8160 GENEVA CT APT 311
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-4659
Practice Address - Country:US
Practice Address - Phone:786-925-7633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst