Provider Demographics
NPI:1346919370
Name:PIEROG, NICOLE CATHERINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:CATHERINE
Last Name:PIEROG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 FLEETWOOD RD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-1762
Mailing Address - Country:US
Mailing Address - Phone:631-599-0832
Mailing Address - Fax:
Practice Address - Street 1:43 FLEETWOOD RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-1762
Practice Address - Country:US
Practice Address - Phone:631-599-0832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool