Provider Demographics
NPI:1760425557
Name:PIMBLE, NICOLE J (LCSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:J
Last Name:PIMBLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:ORELAND
Mailing Address - State:PA
Mailing Address - Zip Code:19075-1810
Mailing Address - Country:US
Mailing Address - Phone:215-559-9011
Mailing Address - Fax:302-652-8297
Practice Address - Street 1:103 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:ORELAND
Practice Address - State:PA
Practice Address - Zip Code:19075-1810
Practice Address - Country:US
Practice Address - Phone:215-559-9011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0143201041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2321214000OtherINDEPENDENCE BC
PA7749232OtherAETNA
PA7749232OtherAETNA