Provider Demographics
NPI:1639383961
Name:NICKERSON, MICHELLE A (MSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:NICKERSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 HERITAGE CIR
Mailing Address - Street 2:
Mailing Address - City:TEATICKET
Mailing Address - State:MA
Mailing Address - Zip Code:02536-5711
Mailing Address - Country:US
Mailing Address - Phone:508-540-2686
Mailing Address - Fax:
Practice Address - Street 1:200 TER HEUN DR
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2525
Practice Address - Country:US
Practice Address - Phone:508-540-6550
Practice Address - Fax:508-540-7480
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical