Provider Demographics
NPI:1205197605
Name:EATON, NICHOLE RENEE (MSED)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:RENEE
Last Name:EATON
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:RENEE
Other - Last Name:SEMPLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:280 PRINCETON AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-1524
Mailing Address - Country:US
Mailing Address - Phone:607-962-3148
Mailing Address - Fax:
Practice Address - Street 1:280 PRINCETON AVENUE EXT
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-1524
Practice Address - Country:US
Practice Address - Phone:607-962-3148
Practice Address - Fax:607-962-8422
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor