Healthcare Provider Details

I. General information

NPI: 1982424578
Provider Name (Legal Business Name): NICHOLAS PHILLIPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N DIVISION ST STE 2A
SALISBURY MD
21801-5039
US

IV. Provider business mailing address

2636 N SALISBURY BLVD
SALISBURY MD
21801-2141
US

V. Phone/Fax

Practice location:
  • Phone: 302-466-5404
  • Fax:
Mailing address:
  • Phone: 661-478-9586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-17201
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: