Provider Demographics
NPI:1881809192
Name:LIVINGSTON, NICOLE J (PHD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:J
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 PINE NEEDLE ST
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-2666
Mailing Address - Country:US
Mailing Address - Phone:732-202-8585
Mailing Address - Fax:732-840-3757
Practice Address - Street 1:300 NORTH AVE E
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2435
Practice Address - Country:US
Practice Address - Phone:908-497-0922
Practice Address - Fax:908-931-0304
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4066103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist