Provider Demographics
NPI:1760191142
Name:SIMPSON, NICOLE ANNE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ANNE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W 122ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-5502
Mailing Address - Country:US
Mailing Address - Phone:917-881-9172
Mailing Address - Fax:
Practice Address - Street 1:107 W 122ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-5502
Practice Address - Country:US
Practice Address - Phone:917-881-9172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118029-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker