Provider Demographics
NPI:1962251462
Name:PATRICIELLO, JOSEPH NICHOLAS (PMHNP, RN)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:NICHOLAS
Last Name:PATRICIELLO
Suffix:
Gender:M
Credentials:PMHNP, RN
Other - Prefix:
Other - First Name:NICHOLAS
Other - Middle Name:
Other - Last Name:PATRICIELLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP
Mailing Address - Street 1:323 HIGHRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-4450
Mailing Address - Country:US
Mailing Address - Phone:914-703-1907
Mailing Address - Fax:
Practice Address - Street 1:21 BLOOMINGDALE RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1504
Practice Address - Country:US
Practice Address - Phone:888-694-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY406121363LP0808X
NY752916163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health