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General NPI Number Information
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NPI Number | 1538599584
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Entity Type | Individual
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Provider Name | NICOLE NOLAN
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Gender | Female
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Dates
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Enumeration Date | 11/12/2013
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Last Update Date | 03/12/2015
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Provider Practice Location Address
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Address Line | 125 20 SUTPHIN BLVD
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City | JAMAICA
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State | NY
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Zip | 11434
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Country | US
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Telephone | 718-322-9086
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Fax |
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Provider Business Mailing Address
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Address Line | 650 SHORE RD APT 3T
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City | LONG BEACH
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State | NY
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Zip | 11561-4649
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Country | US
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Telephone | 516-313-4584
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 089874-1
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License Number State | NY
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