Individual
LISA NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1545 ATLANTIC AVENUE, BROOKLYN, NY 11213
(718) 613-6618
Mailing address
414 E 88TH ST APT 1A, NEW YORK, NY 10128-6684
(917) 257-8481
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
016302-1
NY
Other
Enumeration date
01/04/2007
Last updated
07/08/2007
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