Provider Demographics
NPI:1942202650
Name:NICOSIA, GREGORY JON (PHD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JON
Last Name:NICOSIA
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 1:4927 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1805
Mailing Address - Country:US
Mailing Address - Phone:412-683-8378
Mailing Address - Fax:412-683-1215
Practice Address - Street 1:4927 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-1805
Practice Address - Country:US
Practice Address - Phone:412-683-8378
Practice Address - Fax:412-683-1215
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003167-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist