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General NPI Number Information
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NPI Number | 1326325184
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Entity Type | Organization
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Legal Business Name | NICHOLAS AIELLO PHD PSYCHOLOGIST PLLC
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Dates
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Enumeration Date | 11/08/2011
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Last Update Date | 04/06/2012
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Provider Practice Location Address
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Address Line | 649 RTE. 25A SUITE #5
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City | ROCKY POINT
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State | NY
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Zip | 11778
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Country | US
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Telephone | 631-744-3800
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 5204
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City | ROCKY POINT
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State | NY
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Zip | 11778
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Country | US
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Telephone | 631-744-3800
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | NICHOLAS AIELLO
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Credential | PH.D.
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Telephone | 631-744-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 009476
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License Number State | NY
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