Provider Demographics
NPI:1386314847
Name:GONZALEZ-MESTRES, NYKOLE MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:NYKOLE
Middle Name:MARIE
Last Name:GONZALEZ-MESTRES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 CASCADE ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-1112
Mailing Address - Country:US
Mailing Address - Phone:954-593-0687
Mailing Address - Fax:
Practice Address - Street 1:120 E 2ND ST THIRD FLOOR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1578
Practice Address - Country:US
Practice Address - Phone:814-877-8013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019391103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical