Provider Demographics
NPI:1821161571
Name:MIELE, NICOLE CHRISTINE (LCSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:CHRISTINE
Last Name:MIELE
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 1:838 RAILWAY ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3559
Mailing Address - Country:US
Mailing Address - Phone:570-323-2881
Mailing Address - Fax:570-327-8334
Practice Address - Street 1:926 EAST WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3668
Practice Address - Country:US
Practice Address - Phone:570-327-8446
Practice Address - Fax:570-327-8334
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2020-11-24
Deactivation Date:2020-11-05
Deactivation Code:
Reactivation Date:2020-11-24
Provider Licenses
StateLicense IDTaxonomies
PACW-009156-L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical