Provider Demographics
NPI:1487368734
Name:NICOLE KRIES WYSZYNSKI LCSW
Entity type:Organization
Organization Name:NICOLE KRIES WYSZYNSKI LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MINCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-751-3240
Mailing Address - Street 1:2312 WHITEHORSE MERCERVILLE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1953
Mailing Address - Country:US
Mailing Address - Phone:609-219-1600
Mailing Address - Fax:
Practice Address - Street 1:2312 WHITEHORSE MERCERVILLE RD STE 205
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1953
Practice Address - Country:US
Practice Address - Phone:609-219-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty