Provider Demographics
NPI:1477117661
Name:NEMO, DESIREE'
Entity type:Individual
Prefix:
First Name:DESIREE'
Middle Name:
Last Name:NEMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WHITESBORO ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-3015
Mailing Address - Country:US
Mailing Address - Phone:315-724-5168
Mailing Address - Fax:315-724-6582
Practice Address - Street 1:500 WHITESBORO ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-3015
Practice Address - Country:US
Practice Address - Phone:315-724-5168
Practice Address - Fax:315-724-6582
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)