Provider Demographics
NPI:1720458193
Name:WISSER, NICOLE (LSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:WISSER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 HEPNER RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19526-8115
Mailing Address - Country:US
Mailing Address - Phone:610-207-4163
Mailing Address - Fax:
Practice Address - Street 1:176 HEPNER ROAD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:PA
Practice Address - Zip Code:19526
Practice Address - Country:US
Practice Address - Phone:610-207-4163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)