MEDICARE: NIGEL COURTNEY AUSTIN

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

General Provider Information

NPI Number	:	1962092221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIGEL COURTNEY AUSTIN

Provider Business Mailing Address
First Line	:	110 CEDAR ST STE 10
Second Line	:
City	:	WELLESLEY HILLS
State	:	MA
Zip	:	02481-3527
Country	:	US
Telephone Number	:	617-467-4136
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 CEDAR ST STE 10
Second Line	:
City	:	WELLESLEY HILLS
State	:	MA
Zip	:	02481-3527
Country	:	US
Telephone Number	:	617-467-4136
Fax Number	:

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

Provider Enumeration Date	:	01/21/2021
Last Update Date	:	01/21/2021

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