Provider Demographics
NPI:1316466832
Name:ABDUL-BARI, NICOLE LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:ABDUL-BARI
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 1:123 W CHANDLER HEIGHTS RD UNIT 12786
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-1073
Mailing Address - Country:US
Mailing Address - Phone:480-386-3828
Mailing Address - Fax:
Practice Address - Street 1:650 E INDIAN SCHOOL RD BLDG 31
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1839
Practice Address - Country:US
Practice Address - Phone:602-784-8853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8498-C1041C0700X
AZLCSW-205691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical