Provider Demographics
NPI:1255423257
Name:FALCONE, NICOLE R (LCSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:FALCONE
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 1:222 PROSPECT ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2161
Mailing Address - Country:US
Mailing Address - Phone:413-575-7312
Mailing Address - Fax:
Practice Address - Street 1:110 MAPLE ST
Practice Address - Street 2:CHILD GUIDANCE CLINIC
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1864
Practice Address - Country:US
Practice Address - Phone:413-732-7419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2132071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical