Provider Demographics
NPI:1912504739
Name:MILLER, NICHOLAS JAMES (MS, BCBA)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:JAMES
Last Name:MILLER
Suffix:
Gender:M
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 1:192 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-2641
Mailing Address - Country:US
Mailing Address - Phone:413-636-3574
Mailing Address - Fax:
Practice Address - Street 1:685 BRIGGS STREET
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516
Practice Address - Country:US
Practice Address - Phone:720-849-2668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CO1-20-43539103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst