Provider Demographics
NPI:1336950195
Name:CLAIBORNE, WILLI-NICOLE N
Entity type:Individual
Prefix:
First Name:WILLI-NICOLE
Middle Name:N
Last Name:CLAIBORNE
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 1:110 N 3RD AVE APT 5C
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-1347
Mailing Address - Country:US
Mailing Address - Phone:914-384-9978
Mailing Address - Fax:
Practice Address - Street 1:110 N 3RD AVE APT 5C
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-1347
Practice Address - Country:US
Practice Address - Phone:914-384-9978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor