Healthcare Provider Details

I. General information

NPI: 1255007894
Provider Name (Legal Business Name): NICOLE TRAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ATLANTIC AVE
BROOKLYN NY
11201-6753
US

IV. Provider business mailing address

100 ATLANTIC AVE APT 1E
BROOKLYN NY
11201-6752
US

V. Phone/Fax

Practice location:
  • Phone: 703-915-1031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number095380
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: