Provider Demographics
NPI:1801095013
Name:NICHOLSON, ZOE A (LMHC (EXPECTED 2011))
Entity type:Individual
Prefix:MRS
First Name:ZOE
Middle Name:A
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:LMHC (EXPECTED 2011)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10925-2724
Mailing Address - Country:US
Mailing Address - Phone:201-895-4461
Mailing Address - Fax:
Practice Address - Street 1:621 ROUTE 52
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-1235
Practice Address - Country:US
Practice Address - Phone:845-522-9365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP65338101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty