Provider Demographics
NPI:1700502200
Name:TERRY, NICOLE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:TERRY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 PRINCETON HIGHTSTOWN RD STE 1C
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-1120
Mailing Address - Country:US
Mailing Address - Phone:908-839-8104
Mailing Address - Fax:
Practice Address - Street 1:61 PRINCETON HIGHTSTOWN RD STE 1C
Practice Address - Street 2:
Practice Address - City:PRINCETON JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08550-1120
Practice Address - Country:US
Practice Address - Phone:360-464-1251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC06445100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker