Provider Demographics
NPI:1194812560
Name:CLARE JOANNE NICHOLETTI, LCSW
Entity type:Organization
Organization Name:CLARE JOANNE NICHOLETTI, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MS
Authorized Official - First Name:CLARE
Authorized Official - Middle Name:JOANNE
Authorized Official - Last Name:NICHOLETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-272-8572
Mailing Address - Street 1:903 HANSHAW RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:903 HANSHAW RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1530
Practice Address - Country:US
Practice Address - Phone:607-272-8572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO35134-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty