Provider Demographics
NPI:1336833094
Name:SINANAN, NICOLE ROSE (LAC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ROSE
Last Name:SINANAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ROSE
Other - Last Name:RAHUL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:100 STATE ST APT 544
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5549
Mailing Address - Country:US
Mailing Address - Phone:973-819-4135
Mailing Address - Fax:
Practice Address - Street 1:100 STATE ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5459
Practice Address - Country:US
Practice Address - Phone:973-819-4135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00611700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health