Provider Demographics
NPI:1073668026
Name:KREMER, NICOLE R (PSYD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:KREMER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 W SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6920
Mailing Address - Country:US
Mailing Address - Phone:856-696-7100
Mailing Address - Fax:856-696-9040
Practice Address - Street 1:1237 W SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6920
Practice Address - Country:US
Practice Address - Phone:856-696-7100
Practice Address - Fax:856-696-9040
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ051-A261103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0093645Medicaid
NJQ61624Medicare UPIN
NJ097564UAWMedicare ID - Type Unspecified