MEDICARE: MRS. NICOLE SUZANNE NICKERSON MSW, LCSW

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	104100000X	Social Worker	116125	MA

General Provider Information

NPI Number	:	1316087810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE SUZANNE NICKERSON MSW, LCSW

Provider Business Mailing Address
First Line	:	91 LUPINE RD
Second Line	:
City	:	LOWELL
State	:	MA
Zip	:	01850-1155
Country	:	US
Telephone Number	:	978-866-4257
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 GEORGE ST STE 300
Second Line	:
City	:	LOWELL
State	:	MA
Zip	:	01852-2228
Country	:	US
Telephone Number	:	978-459-2306
Fax Number	:	351-500-8100

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	08/06/2025

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