Provider Demographics
NPI:1073393492
Name:DAYTON, NICOLE PAIGE (LMSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:PAIGE
Last Name:DAYTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 NORTH LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4709
Mailing Address - Country:US
Mailing Address - Phone:631-559-6847
Mailing Address - Fax:
Practice Address - Street 1:999 BRUSH HOLLOW RD
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-1704
Practice Address - Country:US
Practice Address - Phone:516-626-1971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118507-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker