Individual
CARLY P NICHOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BEHAVIOR TECHNICIAN
Contact information
Practice address
756B S BROADWAY, HICKSVILLE, NY 11801-5061
(516) 860-2159
(516) 908-3526
Mailing address
756B S BROADWAY, HICKSVILLE, NY 11801-5061
(516) 860-2159
(516) 908-3526
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
22-239134
NY
Other
Enumeration date
07/10/2023
Last updated
07/10/2023
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