Provider Demographics
NPI:1710337142
Name:NICHOLS, JUDY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:SURF CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08008-5551
Mailing Address - Country:US
Mailing Address - Phone:609-276-1660
Mailing Address - Fax:
Practice Address - Street 1:2012 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:SURF CITY
Practice Address - State:NJ
Practice Address - Zip Code:08008-5551
Practice Address - Country:US
Practice Address - Phone:609-276-1660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056613001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical