Healthcare Provider Details

I. General information

NPI: 1376824912
Provider Name (Legal Business Name): NICOLE L PIERCE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 STONE ST FL 2 COMMUNITY CLINIC OF JEFFERSON COUNTY
WATERTOWN NY
13601-3211
US

IV. Provider business mailing address

10113 STATE ROUTE 812
CASTORLAND NY
13620-1267
US

V. Phone/Fax

Practice location:
  • Phone: 315-782-7445
  • Fax: 315-779-1184
Mailing address:
  • Phone: 315-286-9771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number084629
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: