Provider Demographics
NPI:1669734596
Name:NICHOLS, EDWARD (LCSW)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:EDWARD
Other - Middle Name:
Other - Last Name:ARBUISO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 2141
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NY
Mailing Address - Zip Code:13838-2141
Mailing Address - Country:US
Mailing Address - Phone:607-563-8707
Mailing Address - Fax:607-563-7099
Practice Address - Street 1:22 WEIR ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SIDNEY
Practice Address - State:NY
Practice Address - Zip Code:13838-1022
Practice Address - Country:US
Practice Address - Phone:607-563-8707
Practice Address - Fax:607-563-7099
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027557-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300073367Medicare PIN
NYJ300076497Medicare PIN