Provider Demographics
NPI:1255116257
Name:SPERCZAK, NICOLETTE (LSW)
Entity type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:
Last Name:SPERCZAK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 KINGFISHER CT
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-2504
Mailing Address - Country:US
Mailing Address - Phone:732-551-1547
Mailing Address - Fax:
Practice Address - Street 1:415 ROUTE 34
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2522
Practice Address - Country:US
Practice Address - Phone:732-551-1547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor