Provider Demographics
NPI:1093964991
Name:NICHOLSON, LINDSAY M (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:M
Last Name:NICHOLSON
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 1:152 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-3871
Mailing Address - Country:US
Mailing Address - Phone:337-241-9017
Mailing Address - Fax:337-364-6139
Practice Address - Street 1:152 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3871
Practice Address - Country:US
Practice Address - Phone:337-241-9017
Practice Address - Fax:337-364-6139
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA74631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CX62Medicare PIN