MEDICARE: JEFFREY DIKSA BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-14-15909	DE

General Provider Information

NPI Number	:	1164823845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY DIKSA BCBA

Provider Business Mailing Address
First Line	:	542 AMHERST ST STE B
Second Line	:
City	:	NASHUA
State	:	NH
Zip	:	03063-1016
Country	:	US
Telephone Number	:	610-836-2627
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 DELAWARE AVE STE 102
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19801-1490
Country	:	US
Telephone Number	:	610-836-2627
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2014
Last Update Date	:	05/20/2025

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