Provider Demographics
NPI:1184763492
Name:NICHOLS, MARY CATHERINE (PSYD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT MARION
Mailing Address - State:NY
Mailing Address - Zip Code:12456-6004
Mailing Address - Country:US
Mailing Address - Phone:845-232-8114
Mailing Address - Fax:
Practice Address - Street 1:6339 MILL ST
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1427
Practice Address - Country:US
Practice Address - Phone:845-871-1521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021148-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical