Individual
NICOLE JUANITA INNISS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCAT
Contact information
Practice address
483 CLERMONT AVE, BROOKLYN, NY 11238-2253
(718) 643-5300
Mailing address
1756 W 1ST ST APT 2F, BROOKLYN, NY 11223-1726
(347) 274-5361
Taxonomy
Speciality
Code
Description
License number
State
221700000X
Art Therapist
Primary
002237
NY
Other
Enumeration date
07/23/2018
Last updated
07/23/2018
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