Individual
NICOLE EASTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3744 W CHESTER PIKE, NEWTOWN SQUARE, PA 19073-3224
(610) 864-7376
(877) 599-3340
Mailing address
1167 WEST BALTIMORE PIKE, SUITE 228, MEDIA, PA 19063
(610) 864-7376
(877) 599-3340
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BH003507
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6006824907746020317
MEDICARE
PA
Enumeration date
07/26/2017
Last updated
07/21/2022
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