Healthcare Provider Details

I. General information

NPI: 1962046144
Provider Name (Legal Business Name): NICOLE REUS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 S UNIVERSITY DR
DAVIE FL
33328-5312
US

IV. Provider business mailing address

1257 NW 98TH TER
PEMBROKE PINES FL
33024-4336
US

V. Phone/Fax

Practice location:
  • Phone: 954-513-9545
  • Fax: 407-674-7549
Mailing address:
  • Phone: 786-547-0691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: