Provider Demographics
NPI:1619376852
Name:DOCK, NICOLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:DOCK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:DOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:111 CELESTINO CT
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-4435
Mailing Address - Country:US
Mailing Address - Phone:862-763-7965
Mailing Address - Fax:
Practice Address - Street 1:111 CELESTINO CT
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-4435
Practice Address - Country:US
Practice Address - Phone:862-763-7965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00529200103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical