Provider Demographics
NPI:1306204581
Name:ANISKEVICH, NINA R (LCSW)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:R
Last Name:ANISKEVICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:R
Other - Last Name:ANISKEVICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:511 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TRAPPE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-1923
Mailing Address - Country:US
Mailing Address - Phone:484-464-9681
Mailing Address - Fax:
Practice Address - Street 1:511 W MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TRAPPE
Practice Address - State:PA
Practice Address - Zip Code:19426-1923
Practice Address - Country:US
Practice Address - Phone:484-553-0732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0188641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical