Provider Demographics
NPI:1962607010
Name:CHAIKIN, NICOLE DANIELLA (PSYD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:DANIELLA
Last Name:CHAIKIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SANDY LN
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-3027
Mailing Address - Country:US
Mailing Address - Phone:610-651-0557
Mailing Address - Fax:610-651-0392
Practice Address - Street 1:1171 LANCASTER AVE STE 100
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-2602
Practice Address - Country:US
Practice Address - Phone:484-674-6324
Practice Address - Fax:484-674-6324
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015647103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical