Provider Demographics
NPI:1326557513
Name:WALTERSDORF, NICOLE E (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:E
Last Name:WALTERSDORF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-1723
Mailing Address - Country:US
Mailing Address - Phone:516-509-9151
Mailing Address - Fax:
Practice Address - Street 1:115 STRATFORD RD
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-1723
Practice Address - Country:US
Practice Address - Phone:516-509-9151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0857781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical