Provider Demographics
NPI:1427602606
Name:JOHNSON, NICOY ANIKA
Entity Type:Individual
Prefix:
First Name:NICOY
Middle Name:ANIKA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1092 WILLMOHR ST APT G4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-2621
Mailing Address - Country:US
Mailing Address - Phone:646-472-6102
Mailing Address - Fax:
Practice Address - Street 1:1092 WILLMOHR ST APT G4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-2621
Practice Address - Country:US
Practice Address - Phone:646-472-6102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1333281252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency