Provider Demographics
NPI:1144516907
Name:ROBBINS, NICOLE LEE (LADC I)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEE
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:LADC I
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:BRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1029
Mailing Address - Street 2:
Mailing Address - City:ONSET
Mailing Address - State:MA
Mailing Address - Zip Code:02558-1029
Mailing Address - Country:US
Mailing Address - Phone:781-588-4637
Mailing Address - Fax:
Practice Address - Street 1:801 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-3052
Practice Address - Country:US
Practice Address - Phone:508-586-5977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0036101YA0400X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)