Provider Demographics
NPI:1821728437
Name:MENTON, NICOLE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MENTON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:GERBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 N BRUCE ST
Mailing Address - Street 2:
Mailing Address - City:LADOGA
Mailing Address - State:IN
Mailing Address - Zip Code:47954-7306
Mailing Address - Country:US
Mailing Address - Phone:317-970-3715
Mailing Address - Fax:
Practice Address - Street 1:4326 PATRICIA ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1543
Practice Address - Country:US
Practice Address - Phone:317-226-4261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34009759A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical