Provider Demographics
NPI:1952811523
Name:NICHOLS, EMILY (LSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24727 ROUTE 6 STE 2
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-8257
Mailing Address - Country:US
Mailing Address - Phone:570-265-0100
Mailing Address - Fax:570-265-6741
Practice Address - Street 1:1550 S MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:PA
Practice Address - Zip Code:16933-9586
Practice Address - Country:US
Practice Address - Phone:570-662-7954
Practice Address - Fax:570-662-7753
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW134767104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker