Provider Demographics
NPI:1417253584
Name:NORDQUIST, ABBY (MMFT, LMFT)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:NORDQUIST
Suffix:
Gender:F
Credentials:MMFT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4317 E GENESEE ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-2114
Mailing Address - Country:US
Mailing Address - Phone:315-552-1598
Mailing Address - Fax:315-254-2852
Practice Address - Street 1:4317 E GENESEE ST STE 202
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214-2114
Practice Address - Country:US
Practice Address - Phone:315-552-1598
Practice Address - Fax:315-254-2852
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0763106H00000X
NY001186106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000733194OtherANTHEM