Provider Demographics
NPI:1801147483
Name:MEMOLI, NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MEMOLI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 GRAND ST STE 3
Mailing Address - Street 2:
Mailing Address - City:CROTON ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10520-2371
Mailing Address - Country:US
Mailing Address - Phone:646-644-9480
Mailing Address - Fax:
Practice Address - Street 1:160 W END AVE
Practice Address - Street 2:1N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5601
Practice Address - Country:US
Practice Address - Phone:646-644-9480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0791831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical