Provider Demographics
NPI:1912060369
Name:CASE, NICOLE M (LCSW-R)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:CASE
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:MONIQUE
Other - Last Name:CASE-REID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8 JESSUP LN
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-3502
Mailing Address - Country:US
Mailing Address - Phone:917-287-1435
Mailing Address - Fax:718-303-4313
Practice Address - Street 1:3199 BAINBRIDGE AVE FL 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:917-287-1435
Practice Address - Fax:718-303-4313
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070951-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical