Healthcare Provider Details

I. General information

NPI: 1659791416
Provider Name (Legal Business Name): NICOLE FABRE-NELSON M.S., BSL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10541 DRUMMOND RD
PHILADELPHIA PA
19154-3807
US

IV. Provider business mailing address

3800 CEDARCREST RD
BENSALEM PA
19020-1437
US

V. Phone/Fax

Practice location:
  • Phone: 215-612-7625
  • Fax:
Mailing address:
  • Phone: 267-688-4324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH000119
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: