Christina Nicolais, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

023967 Issued in NY

Practice address

750 East Adams St
Syracuse, NY 13210

Phone

(315) 464-5450

Fax

(315) 454-6322

NPI assigned

Sep 14, 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Virginia Commonwealth University, School of Medicine, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pediatric Service GroupGroup PAC ID 9931007200, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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 and National Provider Directory roles.

• Pediatric Service Group

  • Pediatrics Physician
  • Syracuse, NY
  • NPI 1770539066
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1536883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603929600000",
    "number": "1164905295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 SALINA MEADOWS PKWY",
            "address_2": "STE 100",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132124516",
            "telephone_number": "315-464-2000",
            "fax_number": "315-464-2010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 EAST ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "13210",
            "telephone_number": "315-464-5450",
            "fax_number": "315-454-6322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICOLAIS",
        "first_name": "CHRISTINA",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-14",
        "last_updated": "2020-10-29",
        "certification_date": "2020-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "023967",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1473276",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David William Nickels
• Elizabeth Ann Nickels, SPECIAL ED TEACHER
• Lauren Nickels, NP
• Renee Nickerson, NP
• Refky Nicola, D.O.
• Laura Nicolais, MD
• Brooke Kaliann Nicolaos
• Nicolas Uzcategui Eye Physician and Surgeon PLLC
• Jennifer Leigh Nicolette, N.P
• Rita A Nicoletti, RN

• Psychologist in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.