Healthcare Provider Details

I. General information

NPI: 1134561582
Provider Name (Legal Business Name): NICOLE FRAGALA BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE GAGNON

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 ACCORD PARK DR
NORWELL MA
02061-1606
US

IV. Provider business mailing address

12 MACINTOSH LN
EPPING NH
03042-4400
US

V. Phone/Fax

Practice location:
  • Phone: 603-767-6087
  • Fax:
Mailing address:
  • Phone: 603-767-6087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLABA397
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: