Provider Demographics
NPI:1225826407
Name:BRANTNER, NICOLE PAIGE (LAMFT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:PAIGE
Last Name:BRANTNER
Suffix:
Gender:
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 COLONIAL VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6709
Mailing Address - Country:US
Mailing Address - Phone:717-391-0172
Mailing Address - Fax:717-391-7771
Practice Address - Street 1:1808 COLONIAL VILLAGE LN
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6709
Practice Address - Country:US
Practice Address - Phone:717-391-0172
Practice Address - Fax:717-391-7771
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAMF000052106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist