Provider Demographics
NPI:1417399791
Name:MUCHERINO, NICOLE MARIE (MST)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:MUCHERINO
Suffix:
Gender:F
Credentials:MST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 WEST ST
Mailing Address - Street 2:APT 12W
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-1012
Mailing Address - Country:US
Mailing Address - Phone:203-522-1460
Mailing Address - Fax:
Practice Address - Street 1:90 WEST ST
Practice Address - Street 2:APT 12W
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-1012
Practice Address - Country:US
Practice Address - Phone:203-522-1460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist