Provider Demographics
NPI:1083320485
Name:DYCE, NICOLA ANGELEE (CASAC)
Entity Type:Individual
Prefix:
First Name:NICOLA
Middle Name:ANGELEE
Last Name:DYCE
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 HEBERTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-1809
Mailing Address - Country:US
Mailing Address - Phone:718-356-5100
Mailing Address - Fax:718-356-3155
Practice Address - Street 1:273 HEBERTON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-1809
Practice Address - Country:US
Practice Address - Phone:718-356-5100
Practice Address - Fax:718-356-3155
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty