Provider Demographics
NPI:1457730160
Name:NICHOLS, MARIA (CRPA)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:CRPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24037
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-0037
Mailing Address - Country:US
Mailing Address - Phone:585-478-9056
Mailing Address - Fax:
Practice Address - Street 1:200 FRANK DIMINO WAY APT 203
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1188
Practice Address - Country:US
Practice Address - Phone:585-478-9056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2020-11-18
Deactivation Date:2020-08-11
Deactivation Code:
Reactivation Date:2020-11-18
Provider Licenses
StateLicense IDTaxonomies
NYNYP-006646-2014251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health