DR. NICOLE PETZOLT PSY.D.
NPI 1063836500
Psychologist - Clinical in Brooklyn, NY

Q: What is Nicole Petzolt's NPI number?

The NPI number for Nicole Petzolt is 1063836500. It was assigned to this individual provider in the NPPES registry on February 4, 2014.

Q: What is Nicole Petzolt's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: When was this NPI record last updated?

The NPPES record for Nicole Petzolt was last updated on May 13, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since February 04, 2014PECOS Enrolled

3512 QUENTIN RD STE 110, BROOKLYN, NY 11234(718) 854-8370 Get Directions Write a Review

NPPES record last updated: May 13, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Dr. Nicole Petzolt Psy.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. NICOLE PETZOLT PSY.D. (NPI 1063836500) is an individual clinical provider in Brooklyn, New York, licensed in New York (020428-1) and active in the NPI registry since February 2014. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1063836500

Entity TypeIndividualFemale

Primary Taxonomy103TC0700X

Provider Legal NameDR. NICOLE PETZOLTCredential: PSY.D.

Location Address3512 QUENTIN RD STE 110Brooklyn, NY 11234-4245

Mailing Address3512 Quentin Rd Ste 110Brooklyn, NY 11234-4245 · (718) 854-8370

Phone(718) 854-8370

Sole ProprietorYes

Enumeration DateFebruary 4, 2014

Last NPPES UpdateMay 13, 2021

NPPES CertifiedMay 13, 2021

✔ NPI 1063836500 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in NY · 020428-1

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

Also ListedPsychologistTaxonomy 103T00000X · License 020428-1 (NY)

Also ListedPsychologist · Adult Development & AgingTaxonomy 103TA0700X · License 020428-1 (NY)

3512 QUENTIN RD STE 110, Brooklyn, NY 11234

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Oscar Health Maintenance Organization of Florida, Providence Health Plan, UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Nicole Petzolt Psy.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11234 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$203.53 typical visit price

range $67.40 – $203.53

Typical copayment $50.88 (range $16.85 – $50.88)

Most-billed visit code 99205

Established Patient

$117.62 typical visit price

range $21.66 – $164.45

Typical copayment $29.40 (range $5.41 – $41.11)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RAURA J. DORESTE-MENDEZ PHD

Psychologist (Clinical)