Healthcare Provider Details

I. General information

NPI: 1114358637
Provider Name (Legal Business Name): NICOLE L ZEDERBAUM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 ROSEBERRY ST STE 8
PHILLIPSBURG NJ
08865-1600
US

IV. Provider business mailing address

305 ROSEBERRY ST STE 8
PHILLIPSBURG NJ
08865-1600
US

V. Phone/Fax

Practice location:
  • Phone: 484-822-5700
  • Fax:
Mailing address:
  • Phone: 848-225-7004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05751600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL05851600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: