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General NPI Number Information
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NPI Number | 1194812560
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Entity Type | Organization
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Legal Business Name | CLARE JOANNE NICHOLETTI, LCSW
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 903 HANSHAW RD
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City | ITHACA
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State | NY
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Zip | 14850-1530
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Country | US
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Telephone | 607-272-8572
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Fax |
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Provider Business Mailing Address
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Address Line | 903 HANSHAW RD
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City | ITHACA
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State | NY
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Zip | 14850-1530
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | MS. CLARE JOANNE NICHOLETTI
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Credential |
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Telephone | 607-272-8572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | RO35134-1
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License Number State | NY
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