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NPI Code Detail

MEDICARE: NICOLE LY MSW, MPH

MEDICARE: NICOLE LY MSW, MPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1891447066
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE LY MSW, MPH
Provider Business Mailing Address
First Line : 1614 S 6TH ST APT A
Second Line :
City : ALHAMBRA
State : CA
Zip : 91803-3453
Country : US
Telephone Number : 626-262-3421
Fax Number :
Provider Business Practice Location Address
First Line : 3950 REYNOLDS RD
Second Line :
City : RIVERSIDE
State : CA
Zip : 92503-3517
Country : US
Telephone Number : 951-358-4466
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2022
Last Update Date : 03/01/2024

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