Provider Demographics
NPI:1578717351
Name:NICKAMIN, ANNE VALENTINE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:VALENTINE
Last Name:NICKAMIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:326 HIGHWAY 133
Mailing Address - Street 2:STE A
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-2507
Mailing Address - Country:US
Mailing Address - Phone:970-274-6899
Mailing Address - Fax:
Practice Address - Street 1:326 HIGHWAY 133
Practice Address - Street 2:STE A
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-2507
Practice Address - Country:US
Practice Address - Phone:970-274-6899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99233881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical