Provider Demographics
NPI:1558866582
Name:DEPINTO, NICOLE JESSICA
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:JESSICA
Last Name:DEPINTO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:JESSICA
Other - Last Name:FACCHINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 CROYDEN DR
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6141
Mailing Address - Country:US
Mailing Address - Phone:516-319-3352
Mailing Address - Fax:
Practice Address - Street 1:19 CROYDEN DR
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6141
Practice Address - Country:US
Practice Address - Phone:516-319-3352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency