Provider Demographics
NPI:1508121971
Name:EDWARD NICHOLS EDWARD NICHOLS CONSULTING
Entity Type:Organization
Organization Name:EDWARD NICHOLS EDWARD NICHOLS CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:607-563-8707
Mailing Address - Street 1:22 WEIR ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:SIDNEY
Mailing Address - State:NY
Mailing Address - Zip Code:13838-1022
Mailing Address - Country:US
Mailing Address - Phone:607-563-8707
Mailing Address - Fax:607-563-7099
Practice Address - Street 1:22 WEIR ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SIDNEY
Practice Address - State:NY
Practice Address - Zip Code:13838-1022
Practice Address - Country:US
Practice Address - Phone:607-563-8707
Practice Address - Fax:607-563-7099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0275571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty