Provider Demographics
NPI:1700286366
Name:PIERVENCENTI, NICOLE J (LMHC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:J
Last Name:PIERVENCENTI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-3221
Mailing Address - Country:US
Mailing Address - Phone:917-282-2205
Mailing Address - Fax:631-941-1201
Practice Address - Street 1:348 MAIN ST
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3800
Practice Address - Country:US
Practice Address - Phone:631-941-1200
Practice Address - Fax:631-941-1201
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-01
Last Update Date:2014-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005911-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health