Nicole Intervallo, CASAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

2176 Central Park Ave
Yonkers, NY 10710-1826

Phone

(914) 619-5242

NPI assigned

Oct 27, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Central Park Recovery

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Yonkers, NY
  • NPI 1215543376
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1540598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604793600000",
    "number": "1104393289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 356",
            "city": "YONKERS",
            "state": "NY",
            "postal_code": "107100356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2176 CENTRAL PARK AVE",
            "city": "YONKERS",
            "state": "NY",
            "postal_code": "107101826",
            "telephone_number": "914-619-5242"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20 Church St",
            "address_purpose": "LOCATION",
            "city": "White Plains",
            "state": "NY",
            "postal_code": "106011901",
            "country_code": "US",
            "telephone_number": "914-683-8050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "INTERVALLO",
        "first_name": "NICOLE",
        "credential": "CASAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-27",
        "last_updated": "2020-11-08",
        "certification_date": "2020-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Peter W Ip, RPH
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• Christopher William Isherwood, PHARMD

• Addiction (Substance Use Disorder) Counselor in Yonkers, NY
• Providers in Yonkers, NY by specialty
• Addiction (Substance Use Disorder) Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.