Healthcare Provider Details

I. General information

NPI: 1215740931
Provider Name (Legal Business Name): NICOLE CATERINA RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MILL RUN CT
MEDFORD NJ
08055
US

IV. Provider business mailing address

4 MILL RUN CT
MEDFORD NJ
08055-2436
US

V. Phone/Fax

Practice location:
  • Phone: 609-953-5793
  • Fax: 718-865-5165
Mailing address:
  • Phone: 609-953-5793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-452386
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: