Healthcare Provider Details

I. General information

NPI: 1982272563
Provider Name (Legal Business Name): NICOLE ANN RIORDAN BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 NEWTOWN RD
VIRGINIA BEACH VA
23462-5603
US

IV. Provider business mailing address

544 NEWTOWN RD
VIRGINIA BEACH VA
23462-5603
US

V. Phone/Fax

Practice location:
  • Phone: 224-206-4001
  • Fax:
Mailing address:
  • Phone: 224-206-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: