Basic Information
| Provider Information | |||||||||
| NPI: | 1770777690 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NICOLETTA | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | KYDE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 N MICHIGAN AVE | ||||||||
| Address2: | SUITE # 1900 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606013901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7733212769 | ||||||||
| FaxNumber: | 3125400944 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 WARREN ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021353602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172543800 | ||||||||
| FaxNumber: | 6177791262 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2007 | ||||||||
| LastUpdateDate: | 01/10/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 071.007838 | IL | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.