Derosa, Nicole M

Derosa, Nicole M is an individual health care provider with primary practice located at 100 Intrepid Ln Ste 2 , Syracuse NY 13205-2546. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Behavioral Analyst, Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Psychologist is her primary health care specialty. Derosa, Nicole M can be contacted via phone (315) 797-6241.

Contact Information

Primary practice address
100 Intrepid Ln Ste 2 Syracuse NY 13205-2546
Phone: (315) 797-6241
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X 1107150
Behavioral Health & Social Service Providers / Psychologist 103T00000X 020499 New York

Profile Details

NPI number 1427309228
LBN Legal business name Derosa, Nicole M
Credentials PSY.D., BCBA-D, LBA
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 20th, 2012
Last updated Apr 19th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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