Provider Demographics
NPI:1730691098
Name:CARRERO, NICCOLE (LMHC)
Entity type:Individual
Prefix:
First Name:NICCOLE
Middle Name:
Last Name:CARRERO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 NORTHERN BOULEVARD
Mailing Address - Street 2:SUITE 404- #0830
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1730
Mailing Address - Country:US
Mailing Address - Phone:516-360-0147
Mailing Address - Fax:
Practice Address - Street 1:1129 NORTHERN BOULEVARD
Practice Address - Street 2:SUITE 404- #0830
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-1103
Practice Address - Country:US
Practice Address - Phone:516-360-0147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009055101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty