Nickson, Larissa F
Nickson, Larissa F is an sole proprietor health care provider with primary practice located at 3 3Rd St Ste 20 , Bordentown NJ 08505-1370. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Nickson, Larissa F can be contacted via phone (732) 749-4267.Contact Information
Primary practice address
3 3Rd St Ste 20
Bordentown NJ 08505-1370
Phone: (732) 749-4267
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 44SC05537000 | New Jersey |
Profile Details
| NPI number | 1477869865 |
|---|---|
| LBN Legal business name | Nickson, Larissa F |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 24th, 2010 |
| Last updated | Aug 1st, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1477869865 | NPPES |
| New Jersey | MEDICAID | 4144007 | |
| New Jersey | Other | 31-4011 |
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