Provider Demographics
NPI:1013269133
Name:WELLS-CIMMINO, NICOLE M (LCSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:WELLS-CIMMINO
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 1:1 HUNTERDON RD
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1603
Mailing Address - Country:US
Mailing Address - Phone:862-216-3935
Mailing Address - Fax:973-243-0989
Practice Address - Street 1:1 HUNTERDON RD
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1603
Practice Address - Country:US
Practice Address - Phone:862-216-3935
Practice Address - Fax:973-243-0989
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL055016001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ35-2456163OtherEMPLOYER IDENTIFICATION NUMBER