Provider Demographics
NPI:1801932041
Name:KILLICK, NICHOLAS J (LMHC)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:J
Last Name:KILLICK
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 HAPGOOD RD
Mailing Address - Street 2:
Mailing Address - City:OAKHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01068-9769
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 LAKE ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-3876
Practice Address - Country:US
Practice Address - Phone:508-849-5648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5639101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health