Provider Demographics
NPI:1790910073
Name:NICHOLS, AMY (LICSW)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:CHANDONAIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-3119
Mailing Address - Country:US
Mailing Address - Phone:978-668-3008
Mailing Address - Fax:
Practice Address - Street 1:101 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-3119
Practice Address - Country:US
Practice Address - Phone:978-668-3008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2023-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1164181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical