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NPI Code Detail

MEDICARE: MRS. NICOLE MARIE BALOGH BCBA

MEDICARE: MRS. NICOLE MARIE BALOGH 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
1103K00000XBehavior Analyst1-18-33107FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912442146
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NICOLE MARIE BALOGH BCBA
Provider Business Mailing Address
First Line : 6416 NW 5TH WAY
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33309-6112
Country : US
Telephone Number : 888-754-0398
Fax Number :
Provider Business Practice Location Address
First Line : 5447 E BEAUMONT CENTER BLVD
Second Line :
City : TAMPA
State : FL
Zip : 33634-5210
Country : US
Telephone Number : 888-754-0398
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/26/2016
Last Update Date : 10/10/2019

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