Provider Demographics
NPI:1750178406
Name:LINCOLN, NICOLE SHELBY (LCSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:SHELBY
Last Name:LINCOLN
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 JOYCE DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2369
Mailing Address - Country:US
Mailing Address - Phone:973-417-6002
Mailing Address - Fax:
Practice Address - Street 1:4 S RUSSELL ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7913
Practice Address - Country:US
Practice Address - Phone:973-417-6002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALCSW228821104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker