Provider Demographics
NPI:1114482544
Name:LEFURGY, NICOLE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:LEFURGY
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 1:276 PAMLICO AVE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-5120
Mailing Address - Country:US
Mailing Address - Phone:631-836-2910
Mailing Address - Fax:
Practice Address - Street 1:1375 AKRON ST
Practice Address - Street 2:
Practice Address - City:COPIAGUE
Practice Address - State:NY
Practice Address - Zip Code:11726-2931
Practice Address - Country:US
Practice Address - Phone:631-836-2910
Practice Address - Fax:631-552-4241
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008954101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health