Provider Demographics
NPI:1770777690
Name:NICOLETTA, SARAH KYDE (PSYD)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:KYDE
Last Name:NICOLETTA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N MICHIGAN AVE
Mailing Address - Street 2:SUITE # 1900
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-3901
Mailing Address - Country:US
Mailing Address - Phone:773-321-2769
Mailing Address - Fax:312-540-0944
Practice Address - Street 1:30 WARREN ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3602
Practice Address - Country:US
Practice Address - Phone:617-254-3800
Practice Address - Fax:617-779-1262
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007838103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical