Provider Demographics
NPI:1366086829
Name:KATSIOTAS, NIKKI (PHD)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:KATSIOTAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4326 49TH ST APT B4
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-1316
Mailing Address - Country:US
Mailing Address - Phone:631-786-0454
Mailing Address - Fax:
Practice Address - Street 1:3801 23RD AVE STE 306
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-1978
Practice Address - Country:US
Practice Address - Phone:631-786-0454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023409103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist