Provider Demographics
NPI:1417717448
Name:MCCANE, NIKKI ROSE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NIKKI
Middle Name:ROSE
Last Name:MCCANE
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 1:3117 34TH ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1765
Mailing Address - Country:US
Mailing Address - Phone:440-742-3479
Mailing Address - Fax:
Practice Address - Street 1:3117 34TH ST APT 2C
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-1765
Practice Address - Country:US
Practice Address - Phone:440-742-3479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0963821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical