Provider Demographics
NPI:1225558216
Name:AMARO, NICHOLE LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:LEE
Last Name:AMARO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:AMARO
Other - Last Name:WALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2975 LAUREL ST APT 10
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-5445
Mailing Address - Country:US
Mailing Address - Phone:503-927-2643
Mailing Address - Fax:
Practice Address - Street 1:2975 LAUREL ST APT 10
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-5445
Practice Address - Country:US
Practice Address - Phone:503-927-2643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1166921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical