Basic Information
Provider Information
NPI: 1447550611
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARNOLD
FirstName: NICOLE
MiddleName: PATRICE
NamePrefix:  
NameSuffix:  
Credential: LMSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 10087
Address2:  
City: NEW YORK
State: NY
PostalCode: 102596911
CountryCode: US
TelephoneNumber: 8004446020
FaxNumber: 8452561881
Practice Location
Address1: 16 E 16TH ST
Address2:  
City: NEW YORK
State: NY
PostalCode: 100033105
CountryCode: US
TelephoneNumber: 2129247744
FaxNumber: 2126912786
Other Information
ProviderEnumerationDate: 10/22/2010
LastUpdateDate: 10/22/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000X080297NYY Behavioral Health & Social Service ProvidersSocial Worker 

No ID Information.


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