Healthcare Provider Details

I. General information

NPI: 1730769761
Provider Name (Legal Business Name): NICOLE STEBBINS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 RAILROAD ST STE 4
ST JOHNSBURY VT
05819-1740
US

IV. Provider business mailing address

PO BOX 699
LYNDONVILLE VT
05851-0699
US

V. Phone/Fax

Practice location:
  • Phone: 802-424-1777
  • Fax: 802-448-6905
Mailing address:
  • Phone: 802-424-1042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number146.0134495
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: