Provider Demographics
NPI:1740603166
Name:BRAUCH, NICOLE JOY (LAMFT)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:JOY
Last Name:BRAUCH
Suffix:
Gender:
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 BROOKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2601
Mailing Address - Country:US
Mailing Address - Phone:305-766-8220
Mailing Address - Fax:
Practice Address - Street 1:666 GODWIN AVE STE 230
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1463
Practice Address - Country:US
Practice Address - Phone:551-252-0140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FA00053100106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist