Provider Demographics
NPI:1154956282
Name:QUISPE, NICOLE KIRSTY
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:KIRSTY
Last Name:QUISPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 5TH AVE STE 6115
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10118-6002
Mailing Address - Country:US
Mailing Address - Phone:718-215-5311
Mailing Address - Fax:904-647-2295
Practice Address - Street 1:7365 PRAIRIE FALCON RD STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0808
Practice Address - Country:US
Practice Address - Phone:702-766-9840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLBA0966103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst