Provider Demographics
NPI:1144987512
Name:MIGNOTT-DAVIS, NICOLA
Entity type:Individual
Prefix:
First Name:NICOLA
Middle Name:
Last Name:MIGNOTT-DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 ELMER ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2381
Mailing Address - Country:US
Mailing Address - Phone:862-754-4740
Mailing Address - Fax:
Practice Address - Street 1:224 ELMER ST APT 1
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2381
Practice Address - Country:US
Practice Address - Phone:862-754-4740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-20
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst