Healthcare Provider Details

I. General information

NPI: 1710519558
Provider Name (Legal Business Name): NICOLETTE BAUERMEISTER CERVONI PHD, BCBA, NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13123 E 16TH AVE
AURORA CO
80045-7106
US

IV. Provider business mailing address

1859 28TH ST APT 219
DENVER CO
80216-5245
US

V. Phone/Fax

Practice location:
  • Phone: 727-777-1234
  • Fax:
Mailing address:
  • Phone: 407-416-4252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY.0007179
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12476709
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: