Provider Demographics
NPI:1396529772
Name:ROWE SMALL, NICHOLE GARVINA
Entity type:Individual
Prefix:MS
First Name:NICHOLE
Middle Name:GARVINA
Last Name:ROWE SMALL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NICHOLE
Other - Middle Name:GARVINA
Other - Last Name:ROWE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:184 ELDRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-2992
Mailing Address - Country:US
Mailing Address - Phone:908-718-2875
Mailing Address - Fax:
Practice Address - Street 1:184 ELDRIDGE ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-2992
Practice Address - Country:US
Practice Address - Phone:908-718-2875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker