Provider Demographics
NPI:1962693929
Name:FOGEL, NICOLE K (LCSW)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:K
Last Name:FOGEL
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 1:1844 CAVOLO DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-3901
Mailing Address - Country:US
Mailing Address - Phone:540-848-4779
Mailing Address - Fax:
Practice Address - Street 1:1844 CAVOLO DR
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-3901
Practice Address - Country:US
Practice Address - Phone:540-848-4779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW98161041C0700X
VA09040076521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904007652OtherLCSW
FLSW9816OtherLICENSE IN CLINICAL SOCIAL WORK (LCSW)