Provider Demographics
NPI:1730445453
Name:NICOLOSI, EVA (PSY D)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:NICOLOSI
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 WEYMAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805
Mailing Address - Country:US
Mailing Address - Phone:914-576-4430
Mailing Address - Fax:914-576-4631
Practice Address - Street 1:131 WEYMAN AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10805-1428
Practice Address - Country:US
Practice Address - Phone:914-576-4430
Practice Address - Fax:914-576-4631
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015105103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical