Provider Demographics
NPI:1063688307
Name:SKOUFALOS-SAZAKLIS, NICOLETTA C (PHD)
Entity Type:Individual
Prefix:DR
First Name:NICOLETTA
Middle Name:C
Last Name:SKOUFALOS-SAZAKLIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W 56TH ST
Mailing Address - Street 2:APT 30G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-4312
Mailing Address - Country:US
Mailing Address - Phone:646-820-4693
Mailing Address - Fax:
Practice Address - Street 1:211 W 56TH ST
Practice Address - Street 2:APT 30G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-4312
Practice Address - Country:US
Practice Address - Phone:646-820-4693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019376103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical