Provider Demographics
NPI:1134376874
Name:DAISY-ETIENNE, NICOLE V (PHD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:V
Last Name:DAISY-ETIENNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 N VILLAGE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3701
Mailing Address - Country:US
Mailing Address - Phone:516-255-4100
Mailing Address - Fax:877-728-0102
Practice Address - Street 1:165 N VILLAGE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3761
Practice Address - Country:US
Practice Address - Phone:516-318-2489
Practice Address - Fax:516-255-4101
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017667103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist