Provider Demographics
NPI:1699103473
Name:RETTINO, NICOLE ANTIONETTE (LCSW)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:ANTIONETTE
Last Name:RETTINO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:ANTIONETTE
Other - Last Name:RETTINO-LAMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:501 BAY AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244
Mailing Address - Country:US
Mailing Address - Phone:609-576-8564
Mailing Address - Fax:
Practice Address - Street 1:501 BAY AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244
Practice Address - Country:US
Practice Address - Phone:609-576-8564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-14
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00242200101YA0400X
390200000X
NJ44SC059483001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program