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NPI Code Detail

MEDICARE: NICOLE LAECCA

MEDICARE: NICOLE LAECCA
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
11041C0700XClinical Social Worker091415-1NY

General Provider Information

NPI Number : 1689061152
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE LAECCA
Provider Business Mailing Address
First Line : 504 MCLEAN AVE
Second Line :
City : YONKERS
State : NY
Zip : 10705-4667
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4330 BYRON AVE
Second Line :
City : BRONX
State : NY
Zip : 10466-1608
Country : US
Telephone Number : 718-324-7512
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2015
Last Update Date : 04/22/2015

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Directions to “ NICOLE LAECCA ” Practice Location

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