Provider Demographics
NPI:1114042744
Name:NICOSIA, JESSICA RUTH (LMHC)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:RUTH
Last Name:NICOSIA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-7018
Mailing Address - Country:US
Mailing Address - Phone:631-254-0576
Mailing Address - Fax:
Practice Address - Street 1:313 PLYMOUTH ST
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-7018
Practice Address - Country:US
Practice Address - Phone:631-254-0576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001289101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health