Provider Demographics
NPI:1073528717
Name:HEILMANN, NIKOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:NIKOLE
Middle Name:
Last Name:HEILMANN
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 1:1489 BALTIMORE PIKE
Mailing Address - Street 2:BUILDING 200 SUITE 250
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064
Mailing Address - Country:US
Mailing Address - Phone:610-544-2100
Mailing Address - Fax:610-604-9510
Practice Address - Street 1:1489 BALTIMORE PIKE
Practice Address - Street 2:BUILDING 200 SUITE 250
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064
Practice Address - Country:US
Practice Address - Phone:610-544-2100
Practice Address - Fax:610-604-9510
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0139181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2059599000OtherMHS
PA7827496OtherAETNA
PA1663675OtherPERSONAL CHOICE
PA1663675OtherPERSONAL CHOICE