Provider Demographics
NPI:1407639701
Name:PLUMB, NICHOLE (LSW)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:PLUMB
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 49
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-0049
Mailing Address - Country:US
Mailing Address - Phone:800-413-8020
Mailing Address - Fax:
Practice Address - Street 1:777 ROUTE 70 E STE G101
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2548
Practice Address - Country:US
Practice Address - Phone:800-413-8020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health