Healthcare Provider Details

I. General information

NPI: 1376730960
Provider Name (Legal Business Name): ANN MARIE T NIKOLA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN MARIE TRIPP PENDLETON PSYD

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 ADAM CLAYTON POWELL JR BLVD
NEW YORK NY
10027-3719
US

IV. Provider business mailing address

2139 ADAM CLAYTON POWELL JR BLVD
NEW YORK NY
10027-3719
US

V. Phone/Fax

Practice location:
  • Phone: 347-455-9141
  • Fax:
Mailing address:
  • Phone: 347-455-9141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number018682
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: