Healthcare Provider Details

I. General information

NPI: 1659985786
Provider Name (Legal Business Name): ANDREW ERNEST NUZZOLILLI M.S., BCBA, LABA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2020
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CEDAR HILL ST STE 200
MARLBOROUGH MA
01752-5900
US

IV. Provider business mailing address

225 CEDAR HILL ST STE 200
MARLBOROUGH MA
01752-5900
US

V. Phone/Fax

Practice location:
  • Phone: 877-418-2978
  • Fax: 866-500-2186
Mailing address:
  • Phone: 877-418-2978
  • Fax: 866-500-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberMH-3138-920318
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: