Provider Demographics
NPI:1902962236
Name:BRILLIANT, NICOLE (LCSW)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:BRILLIANT
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 1:38 WHITE ST
Mailing Address - Street 2:#2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3508
Mailing Address - Country:US
Mailing Address - Phone:212-431-5371
Mailing Address - Fax:
Practice Address - Street 1:38 WHITE ST
Practice Address - Street 2:#2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3508
Practice Address - Country:US
Practice Address - Phone:212-431-5371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069900-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN2Y381Medicare Oscar/Certification