Healthcare Provider Details

I. General information

NPI: 1982916813
Provider Name (Legal Business Name): NICOLE QUINTERO PH.D. BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 W ROOSEVELT RD 122 DHSP MC 727
CHICAGO IL
60608-1316
US

IV. Provider business mailing address

1640 W ROOSEVELT RD 122 DHSP, MC 727
CHICAGO IL
60608-1316
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-4664
  • Fax:
Mailing address:
  • Phone: 312-996-4664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.008126
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-10-7131
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: