Provider Demographics
NPI:1669629473
Name:SCHWARZ, NICOLE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SCHWARZ
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 WENTWORTH AVE E
Mailing Address - Street 2:280
Mailing Address - City:WEST ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-3431
Mailing Address - Country:US
Mailing Address - Phone:651-451-2889
Mailing Address - Fax:651-451-5955
Practice Address - Street 1:33 WENTWORTH AVE E
Practice Address - Street 2:280
Practice Address - City:WEST ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-3431
Practice Address - Country:US
Practice Address - Phone:651-451-2889
Practice Address - Fax:651-451-5955
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1478106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist