Provider Demographics
NPI:1003945700
Name:JONES, NICHELLE RENEE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NICHELLE
Middle Name:RENEE
Last Name:JONES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NICHELLE
Other - Middle Name:RENEE
Other - Last Name:BARRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:387 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:TOBYHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18466-8038
Mailing Address - Country:US
Mailing Address - Phone:570-839-4011
Mailing Address - Fax:888-862-7310
Practice Address - Street 1:529 SEVEN BRIDGE RD STE 105
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-7937
Practice Address - Country:US
Practice Address - Phone:570-424-1768
Practice Address - Fax:888-862-7310
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064349104100000X
PACW0150181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACW015018OtherLCSW
PA101401517003Medicaid