1245865898 NPI number — MS. NICOLE MANCUSO LPC, CAADC

Table of content: MS. NICOLE MANCUSO LPC, CAADC (NPI 1245865898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245865898 NPI number — MS. NICOLE MANCUSO LPC, CAADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANCUSO
Provider First Name:
NICOLE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, CAADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MANCUSO-TODD
Provider Other First Name:
NICOLE
Provider Other Middle Name:
MARIELLA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC, CAADC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1245865898
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
126 TIMBER TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18426-2549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
272-772-6551
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 TIMBER TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18426-2549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
272-772-6551
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/04/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  PC018103 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: PC018103 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)