Provider Demographics
NPI:1538739719
Name:NICHOLSON, SUSAN A (M ED)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:A
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:ANGELA
Other - Last Name:CARLINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M ED
Mailing Address - Street 1:177 MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-6637
Mailing Address - Country:US
Mailing Address - Phone:646-418-7953
Mailing Address - Fax:
Practice Address - Street 1:225 BROADHOLLOW RD STE 402
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4899
Practice Address - Country:US
Practice Address - Phone:631-385-7780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist