Basic Information
| Provider Information | |||||||||
| NPI: | 1790088037 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRAITHWAITE | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | COSTA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | COSTA | ||||||||
| OtherFirstName: | NICOLE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 75 MORRIS ST | ||||||||
| Address2: | C/O - WJCS HOSTOS PROGRAM | ||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107051933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143768174 | ||||||||
| FaxNumber: | 9143780180 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 MORRIS STREET | ||||||||
| Address2: | EUGENIO MARIA DE HOSTOS SCHOOL - C/O WJCS | ||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143768174 | ||||||||
| FaxNumber: | 9143780180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2010 | ||||||||
| LastUpdateDate: | 03/15/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 082569 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.