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Organization
NICOLE PAN, LICENSED MENTAL HEALTH COUNSELOR, PLLC
Active
Organization
NICOLE PAN, LICENSED MENTAL HEALTH COUNSELOR, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE PAN (LICENSED MENTAL HEALTH COUNSELOR)
(631) 637-0579
Entity
Organization
Contact information
Practice address
21 GREENE AVE, SUITE 205, AMITYVILLE, NY 11701-2943
(631) 637-0579
Mailing address
PO BOX 1245, FARMINGDALE, NY 11735-0855
(631) 637-0579
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
005554
NY
Other
Enumeration date
11/04/2014
Last updated
05/25/2015
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