Provider Demographics
NPI:1821350752
Name:BRICENO, NADIHUSKA
Entity Type:Individual
Prefix:MRS
First Name:NADIHUSKA
Middle Name:
Last Name:BRICENO
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 1:2510 WESTCHESTER AVE
Mailing Address - Street 2:SUTIE:102
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10461
Mailing Address - Country:US
Mailing Address - Phone:345-582-2305
Mailing Address - Fax:718-425-9679
Practice Address - Street 1:2510 WESTCHESTER AVE
Practice Address - Street 2:SUTIE:102
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:345-582-2305
Practice Address - Fax:718-425-9679
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator