MEDICARE: JANE NOLAN LCSW

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	44SC00295200	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	338239	OTHER	NJ	VALUE OPTIONS
2	4663813	OTHER	NJ	AETNA

General Provider Information

NPI Number	:	1386700870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE NOLAN LCSW

Provider Business Mailing Address
First Line	:	231 CYPRESS POINT DR
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-7158
Country	:	US
Telephone Number	:	609-338-8835
Fax Number	:	609-926-1041

Provider Business Practice Location Address
First Line	:	1645 PALM BEACH LAKES BLVD STE 440
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-2217
Country	:	US
Telephone Number	:	609-338-8835
Fax Number	:	609-926-1041

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	11/11/2019

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Directions to “ JANE NOLAN LCSW” Practice Location

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