Provider Demographics
NPI:1548800519
Name:BATES, NICOLE MARIE (LICSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:BATES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NEW HAMPSHIRE AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-2907
Mailing Address - Country:US
Mailing Address - Phone:207-331-5132
Mailing Address - Fax:833-664-2446
Practice Address - Street 1:1 NEW HAMPSHIRE AVE STE 125
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-2907
Practice Address - Country:US
Practice Address - Phone:207-331-5132
Practice Address - Fax:833-664-2446
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC208341041C0700X
NH23151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MELC20834OtherLICSW
NH2315OtherLICSW