Provider Demographics
NPI:1033657812
Name:STRASSER, NICHOLE (LMSW)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:STRASSER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 MAIN ST NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-6350
Mailing Address - Country:US
Mailing Address - Phone:505-916-5900
Mailing Address - Fax:505-916-5900
Practice Address - Street 1:2212 MAIN ST NE
Practice Address - Street 2:SUITE A
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-6350
Practice Address - Country:US
Practice Address - Phone:505-916-5900
Practice Address - Fax:505-916-5900
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-094561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical