Provider Demographics
NPI:1942767397
Name:DAROSH, NICHOLE LYNN (M ED, BSL, LPC)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:LYNN
Last Name:DAROSH
Suffix:
Gender:F
Credentials:M ED, BSL, LPC
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:LYNN
Other - Last Name:COCCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1105 BERKSHIRE BLVD OFC 110
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1248
Mailing Address - Country:US
Mailing Address - Phone:610-374-4963
Mailing Address - Fax:610-378-5403
Practice Address - Street 1:1105 BERKSHIRE BLVD OFC 110
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1248
Practice Address - Country:US
Practice Address - Phone:610-374-4963
Practice Address - Fax:610-378-5403
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025045820003Medicaid