Provider Demographics
NPI:1437673985
Name:NOLAN, SERA ANAH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SERA
Middle Name:ANAH
Last Name:NOLAN
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 1:1800 AGUA FRIA ST APT B
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-0702
Mailing Address - Country:US
Mailing Address - Phone:312-576-2667
Mailing Address - Fax:
Practice Address - Street 1:1800 AGUA FRIA ST APT B
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-0702
Practice Address - Country:US
Practice Address - Phone:312-576-2667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-100161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical