Provider Demographics
NPI:1043336324
Name:NICKERSON, MICHELLE M (LICSW)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:M
Last Name:NICKERSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 LOW ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3535
Mailing Address - Country:US
Mailing Address - Phone:857-285-8265
Mailing Address - Fax:
Practice Address - Street 1:12 MARKET SQUARE
Practice Address - Street 2:SUITE 2
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913
Practice Address - Country:US
Practice Address - Phone:857-285-8265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13691041C0700X
NH20961041C0700X
MA1211211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical