Provider Demographics
NPI:1063923290
Name:MAIER, NICOLE ELIZABETH (MED, BCBA, LBA-CT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ELIZABETH
Last Name:MAIER
Suffix:
Gender:F
Credentials:MED, BCBA, LBA-CT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ELIZABETH
Other - Last Name:POPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 SOUTH ST UNIT 25
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-8182
Mailing Address - Country:US
Mailing Address - Phone:203-788-5952
Mailing Address - Fax:
Practice Address - Street 1:60 OLD NEW MILFORD ROAD
Practice Address - Street 2:UNIT 1C
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2429
Practice Address - Country:US
Practice Address - Phone:203-788-5952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
CT1394103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist