Healthcare Provider Details

I. General information

NPI: 1346571130
Provider Name (Legal Business Name): NICOLE KRISTEN CID MA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2010
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SE 19TH AVE
POMPANO BEACH FL
33060-7543
US

IV. Provider business mailing address

5540 NW 61ST ST APT 409
COCONUT CREEK FL
33073-2514
US

V. Phone/Fax

Practice location:
  • Phone: 786-774-1510
  • Fax:
Mailing address:
  • Phone: 786-774-1510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: