Provider Demographics
NPI:1770836173
Name:MALCOLM, NICOLE C (LCSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:C
Last Name:MALCOLM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:GOLDSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 LANTERN RD
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-6208
Mailing Address - Country:US
Mailing Address - Phone:516-477-3667
Mailing Address - Fax:
Practice Address - Street 1:40 LANTERN RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-6208
Practice Address - Country:US
Practice Address - Phone:516-477-3667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0877241041C0700X
NY0898881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty