Healthcare Provider Details

I. General information

NPI: 1235153859
Provider Name (Legal Business Name): NICOLE ELIZABETH NOBEL LCSW - R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 MAIN ST SUITE 308
WILLIAMSVILLE NY
14221-6755
US

IV. Provider business mailing address

5500 MAIN ST SUITE 308
WILLIAMSVILLE NY
14221-6755
US

V. Phone/Fax

Practice location:
  • Phone: 716-626-1245
  • Fax: 716-634-3207
Mailing address:
  • Phone: 716-626-1245
  • Fax: 716-634-3207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPR065901-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: