Provider Demographics
NPI:1295580926
Name:NOCKS, JERELL
Entity type:Individual
Prefix:
First Name:JERELL
Middle Name:
Last Name:NOCKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CLENDANIEL AVENUE EXT APT A
Mailing Address - Street 2:
Mailing Address - City:SELBYVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19975-9301
Mailing Address - Country:US
Mailing Address - Phone:443-930-1683
Mailing Address - Fax:
Practice Address - Street 1:7 CLENDANIEL AVENUE EXT APT A
Practice Address - Street 2:
Practice Address - City:SELBYVILLE
Practice Address - State:DE
Practice Address - Zip Code:19975-9301
Practice Address - Country:US
Practice Address - Phone:443-930-1683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities