Provider Demographics
NPI:1033342282
Name:NICO, ILISSA KARA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ILISSA
Middle Name:KARA
Last Name:NICO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 GREEN VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:GREEN VILLAGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07935-3027
Mailing Address - Country:US
Mailing Address - Phone:908-907-7739
Mailing Address - Fax:
Practice Address - Street 1:268 GREEN VILLAGE RD
Practice Address - Street 2:
Practice Address - City:GREEN VILLAGE
Practice Address - State:NJ
Practice Address - Zip Code:07935-3027
Practice Address - Country:US
Practice Address - Phone:908-907-7739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker