Provider Demographics
NPI:1811196587
Name:DESMOND, NICOLE R (MS ETR)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:DESMOND
Suffix:
Gender:F
Credentials:MS ETR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 E MAIN STREET RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-3444
Mailing Address - Country:US
Mailing Address - Phone:585-344-1421
Mailing Address - Fax:585-344-3047
Practice Address - Street 1:5130 E MAIN STREET RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-3444
Practice Address - Country:US
Practice Address - Phone:585-344-1421
Practice Address - Fax:585-344-3047
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health