Nicole Pan, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

21 Greene Ave
Suite 205
Amityville, NY 11701-2943

Phone

(631) 637-0579

NPI assigned

May 12, 2011

Sex

Female

Sole proprietor

Yes

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

Opted out of Medicare

Yes, effective May 3, 2024 through May 3, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Nicole Pan, Licensed Mental Health Counselor, PLLC

  • Mental Health Counselor
  • Amityville, NY
  • NPI 1861897803
  NPD (past) Authorized official

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

{
    "created_epoch": "1305158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436745600000",
    "number": "1790077519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1245",
            "city": "FARMINGDALE",
            "state": "NY",
            "postal_code": "117350855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 GREENE AVE",
            "address_2": "SUITE 205",
            "city": "AMITYVILLE",
            "state": "NY",
            "postal_code": "117012943",
            "telephone_number": "631-637-0579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAN",
        "first_name": "NICOLE",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-05-12",
        "last_updated": "2015-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Ostrowska
• Allison Palazzo, LCSW
• Scott Palma, MA CFA
• Sophia Palmer
• Brittany Christine Palminteri
• Christine Olympia Papadatos, LMSW
• Sophie Pappas
• Geeta Suryaleant Parikh, MD
• Kimberly Parker
• Diane Marie Parker, M.S., CCC/SLP

• Mental Health Counselor in Amityville, NY
• Providers in Amityville, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.