Provider Demographics
NPI:1811430168
Name:NICOLE GERACE LCSW PLLC
Entity type:Organization
Organization Name:NICOLE GERACE LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GERACE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:607-432-9039
Mailing Address - Street 1:8-12 DIETZ ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-1849
Mailing Address - Country:US
Mailing Address - Phone:607-432-9039
Mailing Address - Fax:
Practice Address - Street 1:8-12 DIETZ ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-1849
Practice Address - Country:US
Practice Address - Phone:607-434-9087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR061074251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health