Provider Demographics
NPI:1023364429
Name:LOVETT, NICHOLENA ALEXIS
Entity Type:Individual
Prefix:MS
First Name:NICHOLENA
Middle Name:ALEXIS
Last Name:LOVETT
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 1:54 CARYL AVE
Mailing Address - Street 2:4E
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-4144
Mailing Address - Country:US
Mailing Address - Phone:914-497-3370
Mailing Address - Fax:914-965-5643
Practice Address - Street 1:20 CEDAR ST
Practice Address - Street 2:SUITE 302
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5247
Practice Address - Country:US
Practice Address - Phone:914-576-5292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY738711066174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist