Provider Demographics
NPI:1952691685
Name:EGGER, NICHOLAS BROUGHTON (LCSW)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:BROUGHTON
Last Name:EGGER
Suffix:
Gender:M
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:PO BOX 2593
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95038-2593
Mailing Address - Country:US
Mailing Address - Phone:209-342-7309
Mailing Address - Fax:209-850-9411
Practice Address - Street 1:45 N 1ST ST STE D
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2033
Practice Address - Country:US
Practice Address - Phone:209-342-7309
Practice Address - Fax:669-201-1284
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW713481041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA293579Medicaid
CA1013441898Medicaid