Provider Demographics
NPI:1437045721
Name:BRUMMER, NICOLE MARIE (LAC)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:BRUMMER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:GREEN TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07821-2206
Mailing Address - Country:US
Mailing Address - Phone:973-600-8998
Mailing Address - Fax:
Practice Address - Street 1:245 UNION AVE STE 2C
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3064
Practice Address - Country:US
Practice Address - Phone:908-955-3889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-14
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00873800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health