Healthcare Provider Details

I. General information

NPI: 1922962596
Provider Name (Legal Business Name): NICOLE BERROA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 WOODCLIFF AVE APT D4
NORTH BERGEN NJ
07047-6130
US

IV. Provider business mailing address

464 WOODCLIFF AVE APT D4
NORTH BERGEN NJ
07047-6130
US

V. Phone/Fax

Practice location:
  • Phone: 718-690-5135
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: