Provider Demographics
NPI:1407163215
Name:BABCOCK, NICOLE PATERSON (LCSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:PATERSON
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ANN
Other - Last Name:HANRAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:35 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4703
Mailing Address - Country:US
Mailing Address - Phone:607-206-3815
Mailing Address - Fax:607-722-6245
Practice Address - Street 1:35 FRONT ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4703
Practice Address - Country:US
Practice Address - Phone:607-206-3815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073241104100000X
NY0825511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker