Healthcare Provider Details

I. General information

NPI: 1174745749
Provider Name (Legal Business Name): NICHOLAS FRANK CIMORELLI M.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CHARLES STREET 4E
NEW YORK NY
10014-3013
US

IV. Provider business mailing address

15 CHARLES STREET 4E
NEW YORK NY
10014-3013
US

V. Phone/Fax

Practice location:
  • Phone: 212-647-0096
  • Fax:
Mailing address:
  • Phone: 212-647-0096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR029830-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: