Provider Demographics
NPI:1639482599
Name:NOLASCO, MILEDYS (MSW, CASAC-T)
Entity Type:Individual
Prefix:MISS
First Name:MILEDYS
Middle Name:
Last Name:NOLASCO
Suffix:
Gender:M
Credentials:MSW, CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 WATERS PL
Mailing Address - Street 2:SUITE 2ND FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2700
Mailing Address - Country:US
Mailing Address - Phone:347-493-8556
Mailing Address - Fax:
Practice Address - Street 1:1510 WATERS PL
Practice Address - Street 2:SUITE 2ND FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2700
Practice Address - Country:US
Practice Address - Phone:347-493-8556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY101YA0400XOther101YA0400X