Provider Demographics
NPI:1437818887
Name:NORMAN, NICHOLAS JEFFERY (LICSW)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JEFFERY
Last Name:NORMAN
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 1:900 SW HOLDEN ST APT 306
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-2050
Mailing Address - Country:US
Mailing Address - Phone:801-735-8228
Mailing Address - Fax:
Practice Address - Street 1:900 SW HOLDEN ST APT 306
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-2050
Practice Address - Country:US
Practice Address - Phone:801-735-8228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW609834761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical