Provider Demographics
NPI:1225414691
Name:BRICUYET, NEOLA
Entity type:Individual
Prefix:
First Name:NEOLA
Middle Name:
Last Name:BRICUYET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 STONEHILL DR
Mailing Address - Street 2:UNIT 8
Mailing Address - City:VERNON
Mailing Address - State:NJ
Mailing Address - Zip Code:07462-5587
Mailing Address - Country:US
Mailing Address - Phone:718-514-0038
Mailing Address - Fax:
Practice Address - Street 1:18 W BLACKWELL ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-3841
Practice Address - Country:US
Practice Address - Phone:973-328-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05975300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker