Healthcare Provider Details

I. General information

NPI: 1184909848
Provider Name (Legal Business Name): LOUISE D NIELSEN NCC, LMHC, RPT-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 ROUTE 52
BEACON NY
12508-1235
US

IV. Provider business mailing address

621 ROUTE 52
BEACON NY
12508-1235
US

V. Phone/Fax

Practice location:
  • Phone: 845-527-6880
  • Fax: 845-831-1579
Mailing address:
  • Phone: 845-527-6880
  • Fax: 845-831-1579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000031
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: