Provider Demographics
NPI:1396299640
Name:PIERRE-SMITH, NICOLA
Entity type:Individual
Prefix:
First Name:NICOLA
Middle Name:
Last Name:PIERRE-SMITH
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 1:6725 RIDGE AVE
Mailing Address - Street 2:APARTMENT 110
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2452
Mailing Address - Country:US
Mailing Address - Phone:917-804-9453
Mailing Address - Fax:
Practice Address - Street 1:255 S 7TH ST
Practice Address - Street 2:SUITE 2100
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4135
Practice Address - Country:US
Practice Address - Phone:917-804-9453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008047101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health