| Doctor Name: | MS. KATHERINE NICOSIA |
| NPI Number: | 1063682011 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW,CASAC |
| License Number: | 072578-1 |
| Business Practice Address: | 400 Fort Hill Ave Canandaigua, NY - 144241159 |
| Business Phone Number: | 5853937560 |
| Business Fax Number: | |
| Mailing Address: | 76 Manorshire Dr Apt 3, FAIRPORT |
| State: | NY |
| Postal Code: | 144503430 |
| Phone Number: | 5856623747 |
| Fax Number: | |
| NPI Enumeration Date: | 03/05/2008 |
| NPI Last Update Date: | 03/05/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 072578-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |