Provider Demographics
NPI:1871786822
Name:NICKERSON, GLYNDA LEE (MA, PHD CAND)
Entity type:Individual
Prefix:
First Name:GLYNDA
Middle Name:LEE
Last Name:NICKERSON
Suffix:
Gender:F
Credentials:MA, PHD CAND
Other - Prefix:
Other - First Name:GLYNDIE
Other - Middle Name:
Other - Last Name:NICKERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 813
Mailing Address - Street 2:
Mailing Address - City:WHATELY
Mailing Address - State:MA
Mailing Address - Zip Code:01093-0813
Mailing Address - Country:US
Mailing Address - Phone:310-985-4876
Mailing Address - Fax:
Practice Address - Street 1:241 KING ST
Practice Address - Street 2:SUITE 228
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2335
Practice Address - Country:US
Practice Address - Phone:310-985-4876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2010-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health