Healthcare Provider Details

I. General information

NPI: 1558195941
Provider Name (Legal Business Name): NICOLE F. SCHWARTZ LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 W MAIN ST STE 303
SALISBURY MD
21801-4838
US

IV. Provider business mailing address

3502 JERVIS CT
CLINTON MD
20735-4506
US

V. Phone/Fax

Practice location:
  • Phone: 410-800-2169
  • Fax:
Mailing address:
  • Phone: 202-438-8962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP15503
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: