Provider Demographics
NPI:1932923703
Name:MOJICA, NICOLAS JR (LMSW)
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:
Last Name:MOJICA
Suffix:JR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 SPRING ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-1516
Mailing Address - Country:US
Mailing Address - Phone:518-209-4266
Mailing Address - Fax:
Practice Address - Street 1:1525 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3536
Practice Address - Country:US
Practice Address - Phone:518-209-4266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10662701104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker