MEDICARE: MIRIAM SOLER NICHOLS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1225423155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM SOLER NICHOLS

Provider Business Mailing Address
First Line	:	6550 DELILAH RD
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-5102
Country	:	US
Telephone Number	:	609-272-8580
Fax Number	:	609-645-7343

Provider Business Practice Location Address
First Line	:	16 ROOSEVELT BLVD
Second Line	:
City	:	MARMORA
State	:	NJ
Zip	:	08223-1402
Country	:	US
Telephone Number	:	609-272-8580
Fax Number	:	609-645-7343

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2015
Last Update Date	:	03/30/2015

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Directions to “ MIRIAM SOLER NICHOLS ” Practice Location

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