Provider Demographics
NPI:1417337627
Name:BORZELLECA, NICOLE (LMHC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BORZELLECA
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 1:81 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-4703
Mailing Address - Country:US
Mailing Address - Phone:631-259-7079
Mailing Address - Fax:
Practice Address - Street 1:28 JONES ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2941
Practice Address - Country:US
Practice Address - Phone:631-259-7079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006603101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health