Provider Demographics
NPI:1396823613
Name:SWAIN, NICOLE DANIELLE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:DANIELLE
Last Name:SWAIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 SPRINGFIELD AVE
Mailing Address - Street 2:SUMMIT MEDICAL GROUP
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-1078
Mailing Address - Country:US
Mailing Address - Phone:908-509-8908
Mailing Address - Fax:
Practice Address - Street 1:654 SPRINGFIELD AVE
Practice Address - Street 2:SUMMIT MEDICAL GROUP
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-1078
Practice Address - Country:US
Practice Address - Phone:908-509-8908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00014300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional