Provider Demographics
NPI:1336163062
Name:DIDONATO, NICHOLAS (MA EDS)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:DIDONATO
Suffix:
Gender:M
Credentials:MA EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 BLUE MOUNTAIN LK
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8676
Mailing Address - Country:US
Mailing Address - Phone:570-421-3695
Mailing Address - Fax:
Practice Address - Street 1:59 BEAVERBROOK RD
Practice Address - Street 2:SUITE 303C
Practice Address - City:LINCOLN PARK
Practice Address - State:NJ
Practice Address - Zip Code:07035-1794
Practice Address - Country:US
Practice Address - Phone:973-696-9319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00100600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional