Provider Demographics
NPI:1053567347
Name:QUILTER, NICOLE RENEE (LCSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENEE
Last Name:QUILTER
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 1:27 SHERWOOD HTS
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-3408
Mailing Address - Country:US
Mailing Address - Phone:845-742-7978
Mailing Address - Fax:
Practice Address - Street 1:27 SHERWOOD HTS
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-3408
Practice Address - Country:US
Practice Address - Phone:845-742-7978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074769101YA0400X
NY0772171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)