Provider Demographics
NPI:1609241702
Name:NICOLE BRILL LCSW-R
Entity Type:Organization
Organization Name:NICOLE BRILL LCSW-R
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:EDITH
Authorized Official - Last Name:BRILL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:516-382-3003
Mailing Address - Street 1:47 ESSEX CT
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-4222
Mailing Address - Country:US
Mailing Address - Phone:516-382-3003
Mailing Address - Fax:
Practice Address - Street 1:47 ESSEX CT
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-4222
Practice Address - Country:US
Practice Address - Phone:516-382-3003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0344811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty