Provider Demographics
NPI:1104209204
Name:AMANDA NICELY
Entity Type:Organization
Organization Name:AMANDA NICELY
Other - Org Name:NICELY COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICELY MACHADO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:508-923-1900
Mailing Address - Street 1:205 W GROVE ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-1462
Mailing Address - Country:US
Mailing Address - Phone:508-923-1900
Mailing Address - Fax:508-923-1991
Practice Address - Street 1:205 W GROVE ST
Practice Address - Street 2:SUITE E
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1462
Practice Address - Country:US
Practice Address - Phone:508-923-1900
Practice Address - Fax:508-923-1991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8586101YM0800X
MA8644101YM0800X
MA1155531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty