Provider Demographics
NPI:1093252686
Name:NICOLAOU, ELEFTHERIA (CASACT)
Entity Type:Individual
Prefix:MS
First Name:ELEFTHERIA
Middle Name:
Last Name:NICOLAOU
Suffix:
Gender:F
Credentials:CASACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 160TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3243
Mailing Address - Country:US
Mailing Address - Phone:718-767-2671
Mailing Address - Fax:
Practice Address - Street 1:7901 BROADWAY FL O2
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1329
Practice Address - Country:US
Practice Address - Phone:718-334-5123
Practice Address - Fax:718-334-3183
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30150101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)