Provider Demographics
NPI:1093144131
Name:NICOLSON, TARA (MSW, LSW)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:
Last Name:NICOLSON
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1445 WHITEHORSE MERCERVILLE RD STE 111
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3834
Mailing Address - Country:US
Mailing Address - Phone:609-689-5725
Mailing Address - Fax:609-689-5726
Practice Address - Street 1:1445 WHITEHORSE MERCERVILLE RD STE 111
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3834
Practice Address - Country:US
Practice Address - Phone:609-689-5725
Practice Address - Fax:609-689-5726
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05798200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker