Provider Demographics
NPI:1790088037
Name:BRAITHWAITE, NICOLE COSTA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:COSTA
Last Name:BRAITHWAITE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:COSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 MORRIS ST
Mailing Address - Street 2:C/O - WJCS HOSTOS PROGRAM
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-1933
Mailing Address - Country:US
Mailing Address - Phone:914-376-8174
Mailing Address - Fax:914-378-0180
Practice Address - Street 1:75 MORRIS STREET
Practice Address - Street 2:EUGENIO MARIA DE HOSTOS SCHOOL - C/O WJCS
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705
Practice Address - Country:US
Practice Address - Phone:914-376-8174
Practice Address - Fax:914-378-0180
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082569104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker