Provider Demographics
NPI:1578821898
Name:BANAS, NICOLE MARTEL (LCSW, LLC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARTEL
Last Name:BANAS
Suffix:
Gender:F
Credentials:LCSW, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MAIN ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2445
Mailing Address - Country:US
Mailing Address - Phone:646-831-1135
Mailing Address - Fax:
Practice Address - Street 1:150 MAIN ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2445
Practice Address - Country:US
Practice Address - Phone:646-831-1135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054975001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical