Provider Demographics
NPI:1669230041
Name:METAXA ROZENFELD, NIKOL (MA, NCC, MHC-LP)
Entity type:Individual
Prefix:
First Name:NIKOL
Middle Name:
Last Name:METAXA ROZENFELD
Suffix:
Gender:F
Credentials:MA, NCC, MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 JOHNSON AVE APT 1D
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-1126
Mailing Address - Country:US
Mailing Address - Phone:631-219-3396
Mailing Address - Fax:
Practice Address - Street 1:467 HIGBIE LN
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-2240
Practice Address - Country:US
Practice Address - Phone:631-406-9886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP121942101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health