Provider Demographics
NPI:1235239450
Name:SQUADRONI, NICO Q (LCSW)
Entity Type:Individual
Prefix:
First Name:NICO
Middle Name:Q
Last Name:SQUADRONI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PLAZA DR
Mailing Address - Street 2:#6
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-8823
Mailing Address - Country:US
Mailing Address - Phone:765-778-0380
Mailing Address - Fax:765-778-8328
Practice Address - Street 1:1 PLAZA DR
Practice Address - Street 2:#6
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-8823
Practice Address - Country:US
Practice Address - Phone:765-778-0380
Practice Address - Fax:765-778-8328
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005225A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical