Provider Demographics
NPI:1992058457
Name:BARCLAY, NICOLE G (LICENSED SOCIAL WORK)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:G
Last Name:BARCLAY
Suffix:
Gender:F
Credentials:LICENSED SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:953 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-2733
Mailing Address - Country:US
Mailing Address - Phone:201-915-2000
Mailing Address - Fax:201-433-2426
Practice Address - Street 1:953 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-2733
Practice Address - Country:US
Practice Address - Phone:201-915-2000
Practice Address - Fax:201-433-2426
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05725500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker