Provider Demographics
NPI:1508030735
Name:NICKLAS, NONIE MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:NONIE
Middle Name:MARIE
Last Name:NICKLAS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2146
Mailing Address - Country:US
Mailing Address - Phone:732-939-8908
Mailing Address - Fax:732-333-0897
Practice Address - Street 1:57 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2146
Practice Address - Country:US
Practice Address - Phone:732-939-8908
Practice Address - Fax:732-333-0897
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00157000106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist