Provider Demographics
NPI:1679260988
Name:MACHENRY, NICOLE (LSW LCADC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MACHENRY
Suffix:
Gender:F
Credentials:LSW LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 JOHNSON RD STE 7
Mailing Address - Street 2:
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-1777
Mailing Address - Country:US
Mailing Address - Phone:609-221-3402
Mailing Address - Fax:856-863-3917
Practice Address - Street 1:129 JOHNSON RD STE 7
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-1777
Practice Address - Country:US
Practice Address - Phone:609-221-3402
Practice Address - Fax:856-863-3917
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00361600101YA0400X
NJ44SL06793800104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker