Provider Demographics
NPI:1144873530
Name:MAKEDON, NICOLETTE (LMHC)
Entity type:Individual
Prefix:MS
First Name:NICOLETTE
Middle Name:
Last Name:MAKEDON
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 1:123 GROVE AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2302
Mailing Address - Country:US
Mailing Address - Phone:516-350-8564
Mailing Address - Fax:
Practice Address - Street 1:97 CEDARHURST AVE STE 3
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2140
Practice Address - Country:US
Practice Address - Phone:516-350-8564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009638-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health