Provider Demographics
NPI:1194076794
Name:CIRILLO, NICOLE (LMSW)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:CIRILLO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 OAK ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-6543
Mailing Address - Country:US
Mailing Address - Phone:516-547-8972
Mailing Address - Fax:
Practice Address - Street 1:385 OAK ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-6543
Practice Address - Country:US
Practice Address - Phone:516-547-8972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0870161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LICENSE #- 087016OtherLICENSE #- 087016