Provider Demographics
NPI:1174610182
Name:WALDRON, NICOLE ANN (PSYD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ANN
Last Name:WALDRON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 FRANKLIN ST
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3496
Mailing Address - Country:US
Mailing Address - Phone:973-429-1317
Mailing Address - Fax:888-471-8647
Practice Address - Street 1:348 FRANKLIN ST
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3496
Practice Address - Country:US
Practice Address - Phone:973-429-1317
Practice Address - Fax:888-471-8647
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00410200103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical