Nicole Christine Matocha, PMHNP-BC
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Marcy, NY
NPI 1013433606 · NPPES record last updated Sep 3, 2019
Key facts
- NPI
- 1013433606
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 402212 (NY)
- Practice address
- 9005 Old River Rd
Marcy, NY 13403-3000 - Phone
- (315) 765-3278
- NPI assigned
- Aug 16, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 402212 | NY | MD | Psychiatric/Mental Health Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 402212 | NY | Yes |
Addresses
Primary practice location
9005 Old River Rd
Marcy, NY 13403-3000
Mailing address
9005 Old River Rd
Marcy, NY 13403-3000
Other providers in Marcy, NY
- John B Malecki
- Stephanie Hope Mandelkow
- Raja Mara
- Kaitlin Masopust
- James A Mastroianni
- M. Bridget McKinley
- Nicole Meuse
- Michael S Babula FNP PLLC
- Carol Cecilia Monroe
- Viktoriya Montik
All providers in Marcy, NY · Psychiatric/Mental Health Nurse Practitioner in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 3, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.