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General NPI Number Information
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NPI Number | 1003439753
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Entity Type | Individual
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Provider Name | NICOLE BREZEL LMSW, PSYD
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Gender | Female
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 4277 65TH PL
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City | WOODSIDE
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State | NY
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Zip | 11377-5054
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Country | US
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Telephone | 718-429-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 55 E 87TH ST # 11FG
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City | NEW YORK
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State | NY
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Zip | 10128-1043
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Country | US
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Telephone | 516-592-3847
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 027015
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License Number State | NY
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