Provider Demographics
NPI:1154838464
Name:GERNHARDT, NICOLE BEVERLY (LMHC)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:BEVERLY
Last Name:GERNHARDT
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 1:443 W OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3127
Mailing Address - Country:US
Mailing Address - Phone:516-286-4786
Mailing Address - Fax:
Practice Address - Street 1:55 N OCEAN AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3074
Practice Address - Country:US
Practice Address - Phone:516-855-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009997101YM0800X
NYP09062101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health