Healthcare Provider Details

I. General information

NPI: 1952069551
Provider Name (Legal Business Name): DARLENE YVONNE NICKS MSW, LSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 SOMERSET DR
WILLINGBORO NJ
08046-1442
US

IV. Provider business mailing address

93 SOMERSET DR
WILLINGBORO NJ
08046-1442
US

V. Phone/Fax

Practice location:
  • Phone: 256-701-4502
  • Fax:
Mailing address:
  • Phone: 256-417-5356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW023875
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberPA137936
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: