Provider Demographics
NPI:1851630826
Name:SQUITIERE, NICOLE M (NCC, LPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:SQUITIERE
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 ANGUS RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-3443
Mailing Address - Country:US
Mailing Address - Phone:215-370-9566
Mailing Address - Fax:
Practice Address - Street 1:2091 E HIGH ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3211
Practice Address - Country:US
Practice Address - Phone:610-970-5234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006459101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional