Provider Demographics
NPI:1194098707
Name:NICHOLSON-SANSANI, DARRYL (LCSW)
Entity type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:
Last Name:NICHOLSON-SANSANI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 AMSTERDAM AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-1714
Mailing Address - Country:US
Mailing Address - Phone:347-508-2344
Mailing Address - Fax:
Practice Address - Street 1:1850 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-1714
Practice Address - Country:US
Practice Address - Phone:347-201-0154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC059566001041C0700X
MI68011135731041C0700X
NY0798961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0422877Medicaid