MEDICARE: NICHOLAS PHILLIPS

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	106S00000X	Behavior Technician
2	106E00000X	Assistant Behavior Analyst	0-26-17201	DE

General Provider Information

NPI Number	:	1982424578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS PHILLIPS

Provider Business Mailing Address
First Line	:	2636 N SALISBURY BLVD
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21801-2141
Country	:	US
Telephone Number	:	661-478-9586
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N DIVISION ST STE 2A
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21801-5039
Country	:	US
Telephone Number	:	302-466-5404
Fax Number	:

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

Provider Enumeration Date	:	10/16/2024
Last Update Date	:	06/02/2026

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Directions to “ NICHOLAS PHILLIPS ” Practice Location

Language	Start Address	Practice Location

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