Moody, Nicole

Moody, Nicole is an individual health care provider with primary practice located at 620 Erie Blvd W Ste 208 , Syracuse NY 13204-2457. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counselor, Behavioral Health & Social Service Providers / Marriage & Family Therapist. Behavioral Health & Social Service Providers / Marriage & Family Therapist is her primary health care specialty. Moody, Nicole can be contacted via phone (315) 472-7363.

Contact Information

Primary practice address
620 Erie Blvd W Ste 208 Syracuse NY 13204-2457
Phone: (315) 472-7363
Fax: (315) 701-2368
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X P12131 New York
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X 001645 New York

Profile Details

NPI number 1457831901
LBN Legal business name Moody, Nicole
Credentials LMFT
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 15th, 2018
Last updated Feb 6th, 2020 - about 6 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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Identifiers

StateTypeNumberIssuer
All States NPI 1457831901 NPPES
New York MEDICAID 1336163963

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