Healthcare Provider Details

I. General information

NPI: 1154079184
Provider Name (Legal Business Name): NICOLE FLIBBERT LAURINO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 08/01/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S BROAD ST STE 1700
PHILADELPHIA PA
19110-1007
US

IV. Provider business mailing address

100 S BROAD ST STE 1700
PHILADELPHIA PA
19110-1007
US

V. Phone/Fax

Practice location:
  • Phone: 215-701-1560
  • Fax:
Mailing address:
  • Phone: 301-525-5450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPC013686
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: