Provider Demographics
NPI:1477914414
Name:PIECHOTTE, NICHOLAS J (LCSW, MSW, CADC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
Last Name:PIECHOTTE
Suffix:
Gender:M
Credentials:LCSW, MSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 N HAMILTON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6378
Mailing Address - Country:US
Mailing Address - Phone:810-937-9237
Mailing Address - Fax:
Practice Address - Street 1:1111 N WELLS ST STE 400
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-7632
Practice Address - Country:US
Practice Address - Phone:312-573-8860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.01821211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical