MEDICARE: NICOLE QUILTER LCSW PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1083457063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICOLE QUILTER LCSW PLLC

Provider Business Mailing Address
First Line	:	27 SHERWOOD HTS
Second Line	:
City	:	WAPPINGERS FALLS
State	:	NY
Zip	:	12590-3408
Country	:	US
Telephone Number	:	845-742-7978
Fax Number	:

Provider Business Practice Location Address
First Line	:	27 SHERWOOD HTS
Second Line	:
City	:	WAPPINGERS FALLS
State	:	NY
Zip	:	12590-3408
Country	:	US
Telephone Number	:	845-742-7978
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	NICOLE QUILTER
Credential	:	LCSW
Telephone Number	:	845-742-7978

Provider Enumeration Date	:	06/17/2024
Last Update Date	:	06/17/2024

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