Provider Demographics
NPI:1003311598
Name:ADAMS, NICOLE MARIE (LSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 BUTLER AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6308
Mailing Address - Country:US
Mailing Address - Phone:717-875-4528
Mailing Address - Fax:
Practice Address - Street 1:255 BUTLER AVENUE
Practice Address - Street 2:SUITE 103
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601
Practice Address - Country:US
Practice Address - Phone:717-875-4528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW131731104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103308066001Medicaid