Provider Demographics
NPI:1922555663
Name:AVSHALOMOV, NICOLE RAE LIPPERT (LCSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RAE LIPPERT
Last Name:AVSHALOMOV
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 1:629 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-3410
Mailing Address - Country:US
Mailing Address - Phone:510-957-7651
Mailing Address - Fax:
Practice Address - Street 1:22505 WOODROE AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-3410
Practice Address - Country:US
Practice Address - Phone:510-318-6112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical