Provider Demographics
NPI:1003474750
Name:NELSON, RICHELLE BETH (MHC)
Entity Type:Individual
Prefix:
First Name:RICHELLE
Middle Name:BETH
Last Name:NELSON
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 SYCAMORE AVE STE 39
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-1736
Mailing Address - Country:US
Mailing Address - Phone:631-758-8290
Mailing Address - Fax:
Practice Address - Street 1:64 DIVISION AVE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-2999
Practice Address - Country:US
Practice Address - Phone:631-758-8290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health