Provider Demographics
NPI:1457652802
Name:NIELSEN, KEVIN (LICSW)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:NIELSEN
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 1:64 ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6132
Mailing Address - Country:US
Mailing Address - Phone:802-793-6389
Mailing Address - Fax:
Practice Address - Street 1:64 ORCHARD RD
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6132
Practice Address - Country:US
Practice Address - Phone:802-793-6389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX547641041C0700X
VT089.00635331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical