Provider Demographics
NPI:1164456026
Name:SISSON, NICOLE M (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:SISSON
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:GANNON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LSW
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:SUITE B 3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-6340
Mailing Address - Fax:717-851-6349
Practice Address - Street 1:3550 CONCORD RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8626
Practice Address - Country:US
Practice Address - Phone:717-851-6340
Practice Address - Fax:717-851-6349
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW124543104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker