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General NPI Number Information
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NPI Number | 1376363481
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Entity Type | Individual
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Provider Name | NICOLE BOUSQUET MFT
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Gender | Female
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Dates
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Enumeration Date | 10/14/2024
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 306 W 142ND ST
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City | NEW YORK
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State | NY
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Zip | 10030-1594
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Country | US
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Telephone | 908-376-9302
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Fax |
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Provider Business Mailing Address
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Address Line | 444 S SALINA ST UNIT 186
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City | SYRACUSE
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State | NY
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Zip | 13201-2108
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Country | US
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Telephone | 315-308-1218
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P131512
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License Number State | NY
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