Individual
MS. NICOLE MARIE KANTOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., G.C.ABA, CAN.
Contact information
Practice address
182 CHURCH ST APT 3, NEWTON, MA 02458-1962
(413) 281-0999
Mailing address
182 CHURCH ST APT 3, NEWTON, MA 02458-1962
(413) 281-9999
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
1326587288
MA
222Q00000X
Developmental Therapist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1326587288
NPI
MA
Enumeration date
02/13/2017
Last updated
10/11/2020
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