Provider Demographics
NPI:1386922664
Name:PERRY, NICOLE L (LCSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:PERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:L
Other - Last Name:REBARCHIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:659 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-7012
Mailing Address - Country:US
Mailing Address - Phone:815-344-1999
Mailing Address - Fax:815-516-5171
Practice Address - Street 1:659 RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-7012
Practice Address - Country:US
Practice Address - Phone:815-344-1999
Practice Address - Fax:815-516-5171
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0136861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical