Provider Demographics
NPI:1376824912
Name:PIERCE, NICOLE L (LMSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10113 STATE ROUTE 812
Mailing Address - Street 2:
Mailing Address - City:CASTORLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13620-1267
Mailing Address - Country:US
Mailing Address - Phone:315-286-9771
Mailing Address - Fax:
Practice Address - Street 1:218 STONE ST FL 2
Practice Address - Street 2:COMMUNITY CLINIC OF JEFFERSON COUNTY
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3211
Practice Address - Country:US
Practice Address - Phone:315-782-7445
Practice Address - Fax:315-779-1184
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084629104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker