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General NPI Number Information
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NPI Number | 1750794871
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Entity Type | Individual
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Provider Name | NICOLE LYNN RADICE LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/05/2014
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Last Update Date | 06/05/2014
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Provider Practice Location Address
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Address Line | 8 ANDERSON RD
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City | NORWALK
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State | CT
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Zip | 06851-2402
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Country | US
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Telephone | 203-219-5349
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Fax |
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Provider Business Mailing Address
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Address Line | 8 ANDERSON RD
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City | NORWALK
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State | CT
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Zip | 06851-2402
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Country | US
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Telephone | 203-219-5349
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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 | 7848
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 117566
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1772
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License Number State | NH
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