Doctor Name: | NICOLE STREETS |
NPI Number: | 1093118820 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 551 W Lancaster Ave Haverford, PA - 190411419 |
Business Phone Number: | 6105261974 |
Business Fax Number: | |
Mailing Address: | 549 E High St Apt 2, PHILADELPHIA |
State: | PA |
Postal Code: | 191441141 |
Phone Number: | 2672352039 |
Fax Number: | |
NPI Enumeration Date: | 10/07/2014 |
NPI Last Update Date: | 10/07/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |