Healthcare Provider Details

I. General information

NPI: 1508721614
Provider Name (Legal Business Name): NICOLE SIMMONS MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 W VETERANS HWY
JACKSON NJ
08527-3410
US

IV. Provider business mailing address

89 ELGIN AVE
HADDON TOWNSHIP NJ
08108-2331
US

V. Phone/Fax

Practice location:
  • Phone: 201-979-0772
  • Fax:
Mailing address:
  • Phone: 940-261-1558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: