Provider Demographics
NPI:1871167668
Name:MORRISSEY, NICOLE M (LMT)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:M
Last Name:MORRISSEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 POPLAR LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-1306
Mailing Address - Country:US
Mailing Address - Phone:845-242-2238
Mailing Address - Fax:
Practice Address - Street 1:633 ROUTE 211 E STE 2
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-1781
Practice Address - Country:US
Practice Address - Phone:845-692-3224
Practice Address - Fax:845-692-3426
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019461-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist