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General NPI Number Information
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NPI Number | 1730741034
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Entity Type | Individual
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Provider Name | NICOLE STASIL LCSW, LADC, CCS
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Gender | Female
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Dates
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Enumeration Date | 07/08/2019
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Last Update Date | 02/07/2023
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Provider Practice Location Address
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Address Line | 28 PEARL ST STE 115
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City | BIDDEFORD
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State | ME
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Zip | 04005-4239
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Country | US
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Telephone | 908-635-7815
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Fax |
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Provider Business Mailing Address
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Address Line | 28 PEARL ST STE 115
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City | BIDDEFORD
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State | ME
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Zip | 04005-4239
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Country | US
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Telephone | 908-635-7815
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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