Provider Demographics
NPI:1306448626
Name:BRODY, NICOLE LEIGH (MSED, BCBA)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LEIGH
Last Name:BRODY
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LEIGH
Other - Last Name:FRANCIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NICOLE FRANCIS, BCBA
Mailing Address - Street 1:901 RIO GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6440
Mailing Address - Country:US
Mailing Address - Phone:732-779-4284
Mailing Address - Fax:
Practice Address - Street 1:7 BENSON ST
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-9772
Practice Address - Country:US
Practice Address - Phone:908-208-7614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-20-45645103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst