Provider Demographics
NPI:1013055565
Name:NICHOLS, NANCY (LICSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 BARRETTS MILL RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-1507
Mailing Address - Country:US
Mailing Address - Phone:508-517-1082
Mailing Address - Fax:978-318-0857
Practice Address - Street 1:56 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2076
Practice Address - Country:US
Practice Address - Phone:508-517-1082
Practice Address - Fax:978-318-0857
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1122371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical