Healthcare Provider Details

I. General information

NPI: 1255707089
Provider Name (Legal Business Name): NICOLE CARBONARO BCBA, LBA-NJ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 TURNPIKE RD
SOUTHBOROUGH MA
01772-2108
US

IV. Provider business mailing address

90 MORSE AVE
BLOOMFIELD NJ
07003-2234
US

V. Phone/Fax

Practice location:
  • Phone: 508-481-1015
  • Fax:
Mailing address:
  • Phone: 646-441-7448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: