Provider Demographics
NPI:1851544209
Name:IMBRAGUGLIO, NICOLE LOUISE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:LOUISE
Last Name:IMBRAGUGLIO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5836 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6692
Mailing Address - Country:US
Mailing Address - Phone:919-572-0000
Mailing Address - Fax:919-572-9999
Practice Address - Street 1:5836 FAYETTEVILLE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6692
Practice Address - Country:US
Practice Address - Phone:919-572-0000
Practice Address - Fax:919-572-9999
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3644103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical