Provider Demographics
NPI:1841693801
Name:PATTI O. NICHOLS
Entity type:Organization
Organization Name:PATTI O. NICHOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:O
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:603-494-0682
Mailing Address - Street 1:21 HAMPSHIRE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:NH
Mailing Address - Zip Code:03304-4919
Mailing Address - Country:US
Mailing Address - Phone:603-494-0682
Mailing Address - Fax:
Practice Address - Street 1:201 RIVERWAY PL
Practice Address - Street 2:BEDFORD COMMONS
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6763
Practice Address - Country:US
Practice Address - Phone:603-494-0682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty