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General NPI Number Information
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NPI Number | 1063629624
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Entity Type | Individual
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Provider Name | NICOLE L JACKMAN LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 7 SCHOOL HOUSE AVE STE 101
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City | WESTMINSTER
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State | MD
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Zip | 21157-4566
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Country | US
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Telephone | 410-876-1233
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Fax |
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Provider Business Mailing Address
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Address Line | 1644 SAINT PAUL ST
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City | HAMPSTEAD
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State | MD
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Zip | 21074-2117
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Country | US
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Telephone | 410-257-0430
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12780
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License Number State | MD
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