Healthcare Provider Details

I. General information

NPI: 1326379439
Provider Name (Legal Business Name): LASEANDA NICHOLSON M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2010
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E NEW YORK AVE
BROOKLYN NY
11203-1309
US

IV. Provider business mailing address

1811 LINDEN BLVD
BROOKLYN NY
11207-6742
US

V. Phone/Fax

Practice location:
  • Phone: 491-444-5533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: