Provider Demographics
NPI:1558808899
Name:KAZARICK, NICHOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:KAZARICK
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 1:243 JOHNSTON RD
Mailing Address - Street 2:
Mailing Address - City:UPPER SAINT CLAIR
Mailing Address - State:PA
Mailing Address - Zip Code:15241-2534
Mailing Address - Country:US
Mailing Address - Phone:412-833-6444
Mailing Address - Fax:
Practice Address - Street 1:243 JOHNSTON RD
Practice Address - Street 2:
Practice Address - City:UPPER SAINT CLAIR
Practice Address - State:PA
Practice Address - Zip Code:15241-2534
Practice Address - Country:US
Practice Address - Phone:412-833-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0188841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical