Healthcare Provider Details

I. General information

NPI: 1033587522
Provider Name (Legal Business Name): NICOLE HUTCHINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

786 ROGERS AVE
BROOKLYN NY
11226-3602
US

IV. Provider business mailing address

PO BOX 180262
BROOKLYN NY
11218-0262
US

V. Phone/Fax

Practice location:
  • Phone: 718-676-7869
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001212
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: