Provider Demographics
NPI:1417342379
Name:NICHOLS, DUNCAN (LICSW)
Entity Type:Individual
Prefix:
First Name:DUNCAN
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:THETFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05074-0070
Mailing Address - Country:US
Mailing Address - Phone:802-281-2692
Mailing Address - Fax:
Practice Address - Street 1:321 RT 113
Practice Address - Street 2:LIVERY HOUSE
Practice Address - City:E. THETFORD
Practice Address - State:VT
Practice Address - Zip Code:05043
Practice Address - Country:US
Practice Address - Phone:802-281-2692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01054101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical