Healthcare Provider Details

I. General information

NPI: 1861240517
Provider Name (Legal Business Name): NICOLE DRZEWINSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/22/2025
Certification Date: 05/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BETHANY RD STE 92
HAZLET NJ
07730-1669
US

IV. Provider business mailing address

1 BETHANY RD STE 92
HAZLET NJ
07730-1669
US

V. Phone/Fax

Practice location:
  • Phone: 855-500-3848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00731500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number22-512
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37AC00731500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: