Provider Demographics
NPI:1558776625
Name:PIVKO, NICOLE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:PIVKO
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 GREENWOOD LAKE TPKE
Mailing Address - Street 2:P.O. BOX 1075-G
Mailing Address - City:HEWITT
Mailing Address - State:NJ
Mailing Address - Zip Code:07421-3008
Mailing Address - Country:US
Mailing Address - Phone:973-728-3938
Mailing Address - Fax:
Practice Address - Street 1:1801 GREENWOOD LAKE TPKE
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:NJ
Practice Address - Zip Code:07421-3008
Practice Address - Country:US
Practice Address - Phone:973-728-3938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00436600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health