Individual
DR. NICOLE M DEROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D., BCBA-D, LBA
Contact information
Practice address
100 INTREPID LN STE 2, SYRACUSE, NY 13205-2546
(315) 797-6241
Mailing address
100 INTREPID LN STE 2, SYRACUSE, NY 13205-2546
(315) 797-6241
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1107150
—
103T00000X
Psychologist
Primary
020499
NY
Other
Enumeration date
09/20/2012
Last updated
04/19/2023
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