Provider Demographics
NPI:1821612102
Name:PICCARD, NICHOLAS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:PICCARD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1198 BAYSHORE DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-1468
Mailing Address - Country:US
Mailing Address - Phone:224-715-8174
Mailing Address - Fax:
Practice Address - Street 1:1198 BAYSHORE DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-1468
Practice Address - Country:US
Practice Address - Phone:224-715-8174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490222661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical