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NPI Code Detail

MEDICARE: NICHOLE E MINA

MEDICARE: NICHOLE E MINA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1598259269
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLE E MINA
Provider Business Mailing Address
First Line : 50 W HAWTHORNE AVE
Second Line :
City : VALLEY STREAM
State : NY
Zip : 11580-6220
Country : US
Telephone Number : 516-569-6600
Fax Number :
Provider Business Practice Location Address
First Line : 375 E BAY DR
Second Line :
City : LONG BEACH
State : NY
Zip : 11561-2350
Country : US
Telephone Number : 516-897-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2018
Last Update Date : 01/27/2021

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Directions to “ NICHOLE E MINA ” Practice Location

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