Individual
NICOLE MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
620 ERIE BLVD W STE 208, SYRACUSE, NY 13204-2457
(315) 472-7363
(315) 701-2368
Mailing address
620 ERIE BLVD W STE 208, SYRACUSE, NY 13204-2457
(315) 472-7363
(315) 701-2368
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
P12131
NY
106H00000X
Marriage & Family Therapist
Primary
001645
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336163963
—
NY
Enumeration date
08/15/2018
Last updated
02/06/2020
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