Provider Demographics
NPI:1053770081
Name:MARKS, NICOLE BETH (BCBA)
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:BETH
Last Name:MARKS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 RIDGE RD
Mailing Address - Street 2:A-21
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-2428
Mailing Address - Country:US
Mailing Address - Phone:201-805-8070
Mailing Address - Fax:
Practice Address - Street 1:430 RIDGE RD
Practice Address - Street 2:A-21
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-2428
Practice Address - Country:US
Practice Address - Phone:201-805-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-14-17752103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst