Provider Demographics
NPI:1821746199
Name:NICOLICH, TONI (LCSW)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:NICOLICH
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 1:7 LAURA LN
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:10958-2116
Mailing Address - Country:US
Mailing Address - Phone:516-578-0247
Mailing Address - Fax:
Practice Address - Street 1:372 CHURCH ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3858
Practice Address - Country:US
Practice Address - Phone:845-451-4721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical