Provider Demographics
NPI:1093522138
Name:VITCUSKY, NICOLE ALEXIS
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ALEXIS
Last Name:VITCUSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:ALEXIS
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27 MILLWRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-8023
Mailing Address - Country:US
Mailing Address - Phone:302-241-1185
Mailing Address - Fax:
Practice Address - Street 1:27 MILLWRIGHT DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-8023
Practice Address - Country:US
Practice Address - Phone:302-241-1185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health