Provider Demographics
NPI:1891815874
Name:URDANG, NICOLE SEVERYNA (MS, NCC, DHM)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:SEVERYNA
Last Name:URDANG
Suffix:
Gender:F
Credentials:MS, NCC, DHM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1436
Mailing Address - Country:US
Mailing Address - Phone:716-882-0848
Mailing Address - Fax:
Practice Address - Street 1:650 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-1436
Practice Address - Country:US
Practice Address - Phone:716-882-0848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002563101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health