Provider Demographics
NPI:1114545191
Name:BYRNE-NAVARRO, NICOLE (MS ED CAS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BYRNE-NAVARRO
Suffix:
Gender:F
Credentials:MS ED CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 WILDWOOD EST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-5003
Mailing Address - Country:US
Mailing Address - Phone:151-859-3444
Mailing Address - Fax:
Practice Address - Street 1:128 PARK ROW STE 1000
Practice Address - Street 2:
Practice Address - City:CADYVILLE
Practice Address - State:NY
Practice Address - Zip Code:12918-2817
Practice Address - Country:US
Practice Address - Phone:518-561-6361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1286723181101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool