Organization Name: | NICOLE SESTITO, PH.D. |
NPI Number: | 1215382395 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | NICOLE SESTITO (SOLE PRACTITIONER) |
Mailing Address: | 13 W Third St Media |
State: | PA US |
Postal Code: | 190632803 |
Phone Number: | 6104657312 |
Fax Number: | |
NPI Enumeration Date: | 04/26/2016 |
NPI Last Update Date: | 04/26/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | PS017428 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |