MEDICARE: NICOLE CRONISE BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K-520-630-210-592	OTHER	MD	DRIVER'S LICENSE

General Provider Information

NPI Number	:	1700367687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE CRONISE BCBA

Provider Business Mailing Address
First Line	:	8449 MIRAMAR RD
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-2648
Country	:	US
Telephone Number	:	540-840-6376
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 INTERNATIONAL DR FL 23
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21202-4737
Country	:	US
Telephone Number	:	443-656-9050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2018
Last Update Date	:	12/20/2023

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Directions to “ NICOLE CRONISE BCBA” Practice Location

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