Provider Demographics
NPI:1841483757
Name:WEISMAN, NICOLE (LMSW)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:WEISMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1623
Mailing Address - Country:US
Mailing Address - Phone:845-255-2930
Mailing Address - Fax:845-255-3089
Practice Address - Street 1:279 MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1623
Practice Address - Country:US
Practice Address - Phone:845-255-3046
Practice Address - Fax:845-255-0236
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05174001104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker