Provider Demographics
NPI:1124168885
Name:PARTRIDGE, NICOLE (LBA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:PARTRIDGE
Suffix:
Gender:F
Credentials:LBA
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:DION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LBA
Mailing Address - Street 1:100 CUMMINGS CTR
Mailing Address - Street 2:SUITE 157J
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6115
Mailing Address - Country:US
Mailing Address - Phone:978-969-2894
Mailing Address - Fax:978-969-2637
Practice Address - Street 1:15 PACELLA PARK DR STE 210
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-1700
Practice Address - Country:US
Practice Address - Phone:978-737-3760
Practice Address - Fax:317-815-3861
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-10-7765103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst