Provider Demographics
NPI:1952784803
Name:MILLER, NICOLE KATHERINE (BCBA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:KATHERINE
Last Name:MILLER
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 1:30 CHISWICK RD
Mailing Address - Street 2:APT 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-7131
Mailing Address - Country:US
Mailing Address - Phone:617-955-6968
Mailing Address - Fax:
Practice Address - Street 1:6515 HOLT RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-6903
Practice Address - Country:US
Practice Address - Phone:617-955-6968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst