Provider Demographics
NPI:1093588709
Name:DISALVO, NICOLAS
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:
Last Name:DISALVO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 BROOKLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:PA
Mailing Address - Zip Code:15226-2002
Mailing Address - Country:US
Mailing Address - Phone:724-814-2885
Mailing Address - Fax:724-814-2885
Practice Address - Street 1:520 BROOKLINE BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:PA
Practice Address - Zip Code:15226-2002
Practice Address - Country:US
Practice Address - Phone:724-814-2885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional