Provider Demographics
NPI:1245865898
Name:MANCUSO, NICOLE (LPC, CAADC)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:MANCUSO
Suffix:
Gender:F
Credentials:LPC, CAADC
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:MARIELLA
Other - Last Name:TODD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, CAADC
Mailing Address - Street 1:126 TIMBER TRL
Mailing Address - Street 2:
Mailing Address - City:GREENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18426-2549
Mailing Address - Country:US
Mailing Address - Phone:272-772-6551
Mailing Address - Fax:
Practice Address - Street 1:126 TIMBER TRL
Practice Address - Street 2:
Practice Address - City:GREENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18426-2549
Practice Address - Country:US
Practice Address - Phone:272-772-6551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-04
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC018103251S00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health