Provider Demographics
NPI:1538818430
Name:OHERIEN, NICOLE (LCSW, CASAC)
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:
Last Name:OHERIEN
Suffix:
Gender:F
Credentials:LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 SARATOGA RD APT L8
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-4158
Mailing Address - Country:US
Mailing Address - Phone:315-723-1632
Mailing Address - Fax:
Practice Address - Street 1:133 SARATOGA RD APT L8
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302-4158
Practice Address - Country:US
Practice Address - Phone:315-723-1632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-20
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY37405101YA0400X
NY0965091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)