Provider Demographics
NPI:1598207649
Name:DELGUERCIO, NICHOLAS P (LMHC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:P
Last Name:DELGUERCIO
Suffix:
Gender:M
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:PO BOX 1577
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0894
Mailing Address - Country:US
Mailing Address - Phone:631-751-0413
Mailing Address - Fax:631-751-0540
Practice Address - Street 1:542 N COUNTRY RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-1439
Practice Address - Country:US
Practice Address - Phone:631-751-0413
Practice Address - Fax:631-751-0540
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006480101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health