Provider Demographics
NPI:1720152648
Name:CHRISTINA, NICOLE (LCSW)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:CHRISTINA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:CHRISTINA
Other - Last Name:REEHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:339 SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1725
Mailing Address - Country:US
Mailing Address - Phone:315-426-8330
Mailing Address - Fax:315-426-7887
Practice Address - Street 1:339 SCOTT AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224-1725
Practice Address - Country:US
Practice Address - Phone:315-426-8330
Practice Address - Fax:315-426-7887
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR046172-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical