Provider Demographics
NPI:1821160714
Name:BRECK, NICOLE ANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:ANNE
Last Name:BRECK
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 1:117 E 77TH ST APT 1D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-1823
Mailing Address - Country:US
Mailing Address - Phone:212-472-2797
Mailing Address - Fax:
Practice Address - Street 1:57 ST MARK'S PLACE
Practice Address - Street 2:ST. MARK'S PLACE INSTITUTE FOR MENTAL HEALTH
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-982-3470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5609587UPD1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical