Provider Demographics
NPI:1427373737
Name:HINCKLEY, NICOLE LYNN (LCSW)
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:LYNN
Last Name:HINCKLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 SPRING ST
Mailing Address - Street 2:APT 2
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-3908
Mailing Address - Country:US
Mailing Address - Phone:339-203-5046
Mailing Address - Fax:
Practice Address - Street 1:190 LENOX ST
Practice Address - Street 2:RIVERSIDE ES
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3416
Practice Address - Country:US
Practice Address - Phone:781-769-8674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214883104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker