Provider Demographics
NPI:1861054462
Name:DROST, NICOLE VICTORIA
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:VICTORIA
Last Name:DROST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 W 57TH ST STE 1007
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:640 GEORGE WASHINGTON HWY
Practice Address - Street 2:SUITE B200
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865
Practice Address - Country:US
Practice Address - Phone:401-294-0451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS02221103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical