Provider Demographics
NPI:1356748636
Name:PINTO, NICOLA (LCSW PMHNP)
Entity type:Individual
Prefix:MS
First Name:NICOLA
Middle Name:
Last Name:PINTO
Suffix:
Gender:F
Credentials:LCSW PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 BAYWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-2194
Mailing Address - Country:US
Mailing Address - Phone:973-803-3763
Mailing Address - Fax:877-804-6010
Practice Address - Street 1:2711 IRVIN WAY STE 211
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1724
Practice Address - Country:US
Practice Address - Phone:404-501-0001
Practice Address - Fax:404-501-0023
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055995001041C0700X
GA300926163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical