Provider Demographics
NPI:1356788749
Name:ON COURSE PSYCHOLOGICAL COUNSELING P.C.
Entity type:Organization
Organization Name:ON COURSE PSYCHOLOGICAL COUNSELING P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:VANESSA
Authorized Official - Last Name:DAISY-ETIENNE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-255-4100
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 STE 200
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3701
Practice Address - Country:US
Practice Address - Phone:516-255-4100
Practice Address - Fax:877-728-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-27
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0176671103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty