Healthcare Provider Details

I. General information

NPI: 1548009699
Provider Name (Legal Business Name): NATHANIEL THOMAS PICKERING MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 RICHMOND HILL RD
STATEN ISLAND NY
10314-7509
US

IV. Provider business mailing address

310 RICHMOND HILL RD
STATEN ISLAND NY
10314-7509
US

V. Phone/Fax

Practice location:
  • Phone: 347-286-8691
  • Fax:
Mailing address:
  • Phone: 347-286-8691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: