Healthcare Provider Details

I. General information

NPI: 1427373737
Provider Name (Legal Business Name): NICOLE LYNN HINCKLEY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 LEBANON ST
MELROSE MA
02176-3225
US

IV. Provider business mailing address

585 LEBANON ST
MELROSE MA
02176-3225
US

V. Phone/Fax

Practice location:
  • Phone: 781-979-3300
  • Fax:
Mailing address:
  • Phone: 781-979-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115896
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: