Provider Demographics
NPI:1982332029
Name:KURDYLA, NICOLE H (LCSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:H
Last Name:KURDYLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:KURDYLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:600 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:RARITAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08869-1346
Mailing Address - Country:US
Mailing Address - Phone:908-578-8794
Mailing Address - Fax:
Practice Address - Street 1:1410 DOMINIC ST
Practice Address - Street 2:
Practice Address - City:MANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08835-1916
Practice Address - Country:US
Practice Address - Phone:908-783-3676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053771001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical