Provider Demographics
NPI:1861274961
Name:GARRERA-TOLBERT, NICOLAS (LP)
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:
Last Name:GARRERA-TOLBERT
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 48TH ST APT 2E
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11103-1507
Mailing Address - Country:US
Mailing Address - Phone:929-318-4116
Mailing Address - Fax:
Practice Address - Street 1:303 5TH AVE RM 1410
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6674
Practice Address - Country:US
Practice Address - Phone:929-318-4116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001190102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst