Provider Demographics
NPI:1477136075
Name:PASSARETTI, NICOLE M (PMHNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:PASSARETTI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-2346
Mailing Address - Country:US
Mailing Address - Phone:845-448-9654
Mailing Address - Fax:845-285-9254
Practice Address - Street 1:1075 BROADWAY
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-2346
Practice Address - Country:US
Practice Address - Phone:845-448-9654
Practice Address - Fax:845-285-9254
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403659363LP0808X, 363LP0808X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program