Healthcare Provider Details

I. General information

NPI: 1366090433
Provider Name (Legal Business Name): NICOLE APPELLO LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2019
Last Update Date: 08/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CLINTON PL
HACKENSACK NJ
07601-4579
US

IV. Provider business mailing address

26 HILLIARD AVE APT 5
EDGEWATER NJ
07020-1200
US

V. Phone/Fax

Practice location:
  • Phone: 908-590-2230
  • Fax:
Mailing address:
  • Phone: 908-590-2230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: NICOLE APPELLO
Title or Position: LCSW
Credential: LCSW
Phone: 908-590-2230