MEDICARE: MS. NICOLA A HALL MHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1205602604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLA A HALL MHC

Provider Business Mailing Address
First Line	:	3401 MERRICK RD STE 3
Second Line	:
City	:	WANTAGH
State	:	NY
Zip	:	11793-4343
Country	:	US
Telephone Number	:	516-595-9911
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 MERRICK RD STE 3
Second Line	:
City	:	WANTAGH
State	:	NY
Zip	:	11793-4343
Country	:	US
Telephone Number	:	516-595-9911
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2023
Last Update Date	:	12/22/2023

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