Healthcare Provider Details

I. General information

NPI: 1205440674
Provider Name (Legal Business Name): NICOLE CARCONE BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS NICOLE CARCONE

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 W 1ST ST
OSWEGO NY
13126-2045
US

IV. Provider business mailing address

10 BRANTWOOD RD
UTICA NY
13501-6607
US

V. Phone/Fax

Practice location:
  • Phone: 315-342-9575
  • Fax:
Mailing address:
  • Phone: 315-797-6241
  • Fax: 315-749-7054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number002045
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: