Healthcare Provider Details

I. General information

NPI: 1104352624
Provider Name (Legal Business Name): NICHOLAS LABARGE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 W HORSESHOE DR
BEVERLY HILLS FL
34465-2955
US

IV. Provider business mailing address

4350 W HORSESHOE DR
BEVERLY HILLS FL
34465-2955
US

V. Phone/Fax

Practice location:
  • Phone: 678-656-9362
  • Fax:
Mailing address:
  • Phone: 678-656-9362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: