Provider Demographics
NPI:1871765560
Name:NICHOLS, AMY MICHELLE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MICHELLE
Last Name:NICHOLS
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 1:21 GEORGE ST FL 1
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-2228
Mailing Address - Country:US
Mailing Address - Phone:978-453-5736
Mailing Address - Fax:
Practice Address - Street 1:21 GEORGE ST FL 1
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-2228
Practice Address - Country:US
Practice Address - Phone:978-453-5736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005123A1041C0700X
MA1226831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical