Provider Demographics
NPI:1992220354
Name:LINET, NICOLE (LICSW)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:
Last Name:LINET
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:TATIANA
Other - Middle Name:
Other - Last Name:HADLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:525 PORTLAND AVE # MC693
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1533
Mailing Address - Country:US
Mailing Address - Phone:612-596-1223
Mailing Address - Fax:612-677-1223
Practice Address - Street 1:525 PORTLAND AVE # MC693
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1533
Practice Address - Country:US
Practice Address - Phone:612-596-1223
Practice Address - Fax:612-677-1223
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN271061041C0700X
NYP07357104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker