Provider Demographics
NPI:1427582634
Name:TRAYLOR, NICOLE (MSW,CAADC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:TRAYLOR
Suffix:
Gender:F
Credentials:MSW,CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 FARADAY CT
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-3064
Mailing Address - Country:US
Mailing Address - Phone:302-203-8081
Mailing Address - Fax:
Practice Address - Street 1:112 FARADAY CT
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-3064
Practice Address - Country:US
Practice Address - Phone:302-203-8081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health