Healthcare Provider Details

I. General information

NPI: 1588815633
Provider Name (Legal Business Name): KATHLEEN NICOSIA MT-BC, NMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 LAUREL OAK RD
VOORHEES NJ
08043-3512
US

IV. Provider business mailing address

505 5TH AVE
BELLMAWR NJ
08031-1426
US

V. Phone/Fax

Practice location:
  • Phone: 856-346-0005
  • Fax:
Mailing address:
  • Phone: 732-859-6027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number08006
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: