Provider Demographics
NPI:1164981775
Name:KANIA, NICOLE PANZA (LPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:PANZA
Last Name:KANIA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 W COMMODORE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-5372
Mailing Address - Country:US
Mailing Address - Phone:732-780-2799
Mailing Address - Fax:
Practice Address - Street 1:1021 W COMMODORE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-5372
Practice Address - Country:US
Practice Address - Phone:732-780-2799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional