Provider Demographics
NPI:1356908123
Name:MARSHALL, NICOLETTE LIN (LCSW)
Entity type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:LIN
Last Name:MARSHALL
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 1:1275 DELAWARE AVE STE B100
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2412
Mailing Address - Country:US
Mailing Address - Phone:716-771-0776
Mailing Address - Fax:
Practice Address - Street 1:1275 DELAWARE AVE STE B100
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2412
Practice Address - Country:US
Practice Address - Phone:716-771-0776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0977521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical