Provider Demographics
NPI:1053316307
Name:PAPPAS, NICHOLAS ALEXANDER (PHD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ALEXANDER
Last Name:PAPPAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:NICHOLAS
Other - Middle Name:ALEXANDER
Other - Last Name:PAPPAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:315 TOWNHOUSE
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033
Mailing Address - Country:US
Mailing Address - Phone:717-533-7575
Mailing Address - Fax:717-533-7575
Practice Address - Street 1:315 TOWNHOUSE
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033
Practice Address - Country:US
Practice Address - Phone:717-533-7575
Practice Address - Fax:717-533-7575
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007850L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA324529Medicare ID - Type Unspecified