Healthcare Provider Details

I. General information

NPI: 1205500618
Provider Name (Legal Business Name): NICOLLE ANESA TURSENOVIC M.S., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HILL CT
WHITESTONE NY
11357-2363
US

IV. Provider business mailing address

9 HILL CT
WHITESTONE NY
11357-2363
US

V. Phone/Fax

Practice location:
  • Phone: 718-216-6563
  • Fax:
Mailing address:
  • Phone: 718-216-6563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-50203
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number210068940
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number002138
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: