Provider Demographics
NPI:1164925418
Name:NIKOLITS, GWYNNE A (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:GWYNNE
Middle Name:A
Last Name:NIKOLITS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ESTATE DR APT 208
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3539
Mailing Address - Country:US
Mailing Address - Phone:617-470-5267
Mailing Address - Fax:
Practice Address - Street 1:45 UNION ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-6056
Practice Address - Country:US
Practice Address - Phone:508-433-4442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1194071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical