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General NPI Number Information
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NPI Number | 1346571130
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Entity Type | Individual
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Provider Name | NICOLE KRISTEN CID MA, BCBA
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Gender | Female
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Dates
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Enumeration Date | 01/19/2010
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Last Update Date | 09/21/2020
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Provider Practice Location Address
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Address Line | 200 SE 19TH AVE
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City | POMPANO BEACH
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State | FL
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Zip | 33060-7543
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Country | US
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Telephone | 786-774-1510
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Fax |
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Provider Business Mailing Address
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Address Line | 5540 NW 61ST ST APT 409
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City | COCONUT CREEK
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State | FL
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Zip | 33073-2514
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Country | US
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Telephone | 786-774-1510
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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