Provider Demographics
NPI:1588958037
Name:BATES, NISSA GOLDBERG (BCBA)
Entity type:Individual
Prefix:MRS
First Name:NISSA
Middle Name:GOLDBERG
Last Name:BATES
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1284 DOWNING ST # 201
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-2179
Mailing Address - Country:US
Mailing Address - Phone:505-507-7607
Mailing Address - Fax:
Practice Address - Street 1:1284 DOWNING ST # 201
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-2179
Practice Address - Country:US
Practice Address - Phone:505-507-7607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst