Provider Demographics
NPI:1053364356
Name:PIPER, NICOLE D (LCSW)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:D
Last Name:PIPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 GERALD AVE
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33972-2324
Mailing Address - Country:US
Mailing Address - Phone:239-368-0271
Mailing Address - Fax:
Practice Address - Street 1:1512 GERALD AVE
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33972-2324
Practice Address - Country:US
Practice Address - Phone:239-368-0271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW96551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDESW28951Medicare ID - Type Unspecified
OHQ38543Medicare UPIN