Provider Demographics
NPI:1215943873
Name:CETERSKI, NICOLE (LMSW-CC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CETERSKI
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 ELM ST APT A
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1440
Mailing Address - Country:US
Mailing Address - Phone:207-798-1228
Mailing Address - Fax:207-373-6959
Practice Address - Street 1:66 BARIBEAU DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3230
Practice Address - Country:US
Practice Address - Phone:207-373-6950
Practice Address - Fax:207-373-6959
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC10381104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432148599Medicaid