Healthcare Provider Details

I. General information

NPI: 1144068420
Provider Name (Legal Business Name): NICHOLAS JOSEPH DEAN-ANDREWS BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: NICHOLAS DEAN

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

787 SWISS OAKS CT
ST JOHNS FL
32259-9095
US

IV. Provider business mailing address

787 SWISS OAKS CT
ST JOHNS FL
32259-9095
US

V. Phone/Fax

Practice location:
  • Phone: 904-588-2540
  • Fax:
Mailing address:
  • Phone: 904-588-2540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133005428
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: