Provider Demographics
NPI:1700597309
Name:WARNER, NICOLE (LICSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:WARNER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 LOVETT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5122
Mailing Address - Country:US
Mailing Address - Phone:401-450-1426
Mailing Address - Fax:
Practice Address - Street 1:12 LOVETT ST APT 2
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-5122
Practice Address - Country:US
Practice Address - Phone:401-450-1426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA125875104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker