Provider Demographics
NPI:1639166929
Name:NICHOLSON III, HARVEY CURTIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:CURTIS
Last Name:NICHOLSON III
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:CURT
Other - Middle Name:
Other - Last Name:NICHOLSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:57 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-1941
Mailing Address - Country:US
Mailing Address - Phone:717-627-2857
Mailing Address - Fax:717-627-4455
Practice Address - Street 1:57 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-1941
Practice Address - Country:US
Practice Address - Phone:717-627-2857
Practice Address - Fax:717-627-4455
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-004493-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPS-004493-LOtherPSYCHOLOGY LICENSE
PAR06000Medicare UPIN
PA090541QGYMedicare ID - Type Unspecified
PAPS-004493-LOtherPSYCHOLOGY LICENSE