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General NPI Number Information
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NPI Number | 1679863237
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Entity Type | Individual
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Provider Name | NICOLE M VENDETTE BCBA
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Gender | Female
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Dates
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Enumeration Date | 04/15/2011
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 10272 S US HIGHWAY 1
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-5615
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Country | US
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Telephone | 407-947-4675
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Fax | 772-209-6900
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Provider Business Mailing Address
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Address Line | 3344 NE SANDRA DR
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City | JENSEN BEACH
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State | FL
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Zip | 34957-3972
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Country | US
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Telephone | 407-947-4675
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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 | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 11410241
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 11410241
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License Number State | FL
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