Provider Demographics
NPI:1811497936
Name:NICHOLS, CAM TU (LCSW)
Entity type:Individual
Prefix:
First Name:CAM TU
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 W 1ST ST S
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-2231
Mailing Address - Country:US
Mailing Address - Phone:315-720-3161
Mailing Address - Fax:
Practice Address - Street 1:29 E CAYUGA ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-1241
Practice Address - Country:US
Practice Address - Phone:315-326-4100
Practice Address - Fax:315-326-4229
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0826561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical