Provider Demographics
NPI:1952757114
Name:NICOSON, MARCY (LCSW)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:
Last Name:NICOSON
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 1:111 S MAIN ST
Mailing Address - Street 2:PO BOX 238
Mailing Address - City:FITHIAN
Mailing Address - State:IL
Mailing Address - Zip Code:61844-5251
Mailing Address - Country:US
Mailing Address - Phone:217-766-9540
Mailing Address - Fax:
Practice Address - Street 1:111 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FITHIAN
Practice Address - State:IL
Practice Address - Zip Code:61844-5251
Practice Address - Country:US
Practice Address - Phone:217-766-9540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0140161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical