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NPI Code Detail

MEDICARE: NICOLE GOLDMAN MA, BCBA, LBA

MEDICARE: NICOLE GOLDMAN MA, BCBA, LBA
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
1247200000XOther Technician
2103K00000XBehavior Analyst7401001577MI

General Provider Information

NPI Number : 1922537273
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE GOLDMAN MA, BCBA, LBA
Provider Business Mailing Address
First Line : 33464 SCHOENHERR RD STE 180
Second Line :
City : STERLING HEIGHTS
State : MI
Zip : 48312-6392
Country : US
Telephone Number : 586-999-5971
Fax Number : 248-712-4318
Provider Business Practice Location Address
First Line : 33464 SCHOENHERR RD STE 180
Second Line :
City : STERLING HEIGHTS
State : MI
Zip : 48312-6392
Country : US
Telephone Number : 586-999-5971
Fax Number : 248-712-4318
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2017
Last Update Date : 06/08/2026

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