Healthcare Provider Details

I. General information

NPI: 1982237012
Provider Name (Legal Business Name): NICOLE LINAWEAVER LBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 BYBERRY RD STE 1404
HUNTINGDON VALLEY PA
19006-3526
US

IV. Provider business mailing address

1800 BYBERRY RD STE 1404
HUNTINGDON VALLEY PA
19006-3526
US

V. Phone/Fax

Practice location:
  • Phone: 267-388-0670
  • Fax: 267-344-7087
Mailing address:
  • Phone: 267-388-0670
  • Fax: 215-344-7087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH006419
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-99922
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: