Provider Demographics
NPI:1174699581
Name:NORTON, NICHOLAS CHARLES (PHD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:CHARLES
Last Name:NORTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E 23RD ST
Mailing Address - Street 2:SUITE NUMBER 5A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5012
Mailing Address - Country:US
Mailing Address - Phone:212-475-8579
Mailing Address - Fax:
Practice Address - Street 1:510 E 23RD ST
Practice Address - Street 2:SUITE NUMBER 5A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5012
Practice Address - Country:US
Practice Address - Phone:212-475-8579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009972103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01574249Medicaid
NYS09972-1BOtherWORKMAN'S COMPENSATION ID
NY019756OtherVALUE OPTIONS NUMBER
NY1057160OtherBEACON HEALTH ID NUMBER
NY4676291OtherAETNA PROVIDER ID NUMBER
NY6803269OtherGHI NUMBER
NY01574249Medicaid