Provider Demographics
NPI:1821602103
Name:NICHOLS, RILEY FOSTER (LMSW)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:FOSTER
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 THAMES ST APT 205
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-1774
Mailing Address - Country:US
Mailing Address - Phone:517-974-7756
Mailing Address - Fax:
Practice Address - Street 1:7439 MIDDLEBELT RD STE 3
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4183
Practice Address - Country:US
Practice Address - Phone:517-974-7756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110200104100000X
MI6801115881104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker