Individual
NICOLE INTERVALLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASAC
Contact information
Practice address
2176 CENTRAL PARK AVE, YONKERS, NY 10710-1826
(914) 619-5242
Mailing address
PO BOX 356, YONKERS, NY 10710-0356
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
10/27/2018
Last updated
11/08/2020
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