Provider Demographics
NPI:1306928726
Name:HALPERN, NICOLE JALAZO (LCSW, RPT)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:JALAZO
Last Name:HALPERN
Suffix:
Gender:F
Credentials:LCSW, RPT
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:ERIN
Other - Last Name:JALAZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, RPT
Mailing Address - Street 1:108A SOUTH COLUMBUS STREET
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314
Mailing Address - Country:US
Mailing Address - Phone:202-253-7503
Mailing Address - Fax:
Practice Address - Street 1:108A S COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3051
Practice Address - Country:US
Practice Address - Phone:202-253-7503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040063271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical