Provider Demographics
NPI:1699173617
Name:NICKENS, LINDSAY NICOLE
Entity type:Individual
Prefix:MS
First Name:LINDSAY
Middle Name:NICOLE
Last Name:NICKENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 E 66TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6148
Mailing Address - Country:US
Mailing Address - Phone:212-328-9182
Mailing Address - Fax:
Practice Address - Street 1:53 E 66TH ST STE A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6148
Practice Address - Country:US
Practice Address - Phone:212-328-9182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-08
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093170-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical