Provider Demographics
NPI:1679508287
Name:XAVIER, NICOLE M (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:M
Last Name:XAVIER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:773 CONCOURSE VLG E
Mailing Address - Street 2:15 C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-3903
Mailing Address - Country:US
Mailing Address - Phone:718-588-2620
Mailing Address - Fax:
Practice Address - Street 1:3722 82ND ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7032
Practice Address - Country:US
Practice Address - Phone:718-779-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR052239-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY47409EMedicare UPIN