Provider Demographics
NPI:1720673254
Name:PORTER, NICOLE PIAZZA (MA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:PIAZZA
Last Name:PORTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BLEECKER ST APT 2D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-8043
Mailing Address - Country:US
Mailing Address - Phone:845-416-4657
Mailing Address - Fax:
Practice Address - Street 1:15211 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3908
Practice Address - Country:US
Practice Address - Phone:718-990-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-06
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent