Healthcare Provider Details

I. General information

NPI: 1700656261
Provider Name (Legal Business Name): NICOLAS JORDAN MARASCO MA, RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 GRAND REGENCY BLVD
BRANDON FL
33510-3935
US

IV. Provider business mailing address

9365 COUNSELORS ROW STE 200
INDIANAPOLIS IN
46240-6418
US

V. Phone/Fax

Practice location:
  • Phone: 813-709-7989
  • Fax: 317-520-8200
Mailing address:
  • Phone: 855-324-0885
  • Fax: 317-520-8200

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 NumberRBT-23-315173
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: