MEDICARE: EMILY NICHOLS LSW

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	SW134767	PA

General Provider Information

NPI Number	:	1952811523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY NICHOLS LSW

Provider Business Mailing Address
First Line	:	24727 ROUTE 6 STE 2
Second Line	:
City	:	TOWANDA
State	:	PA
Zip	:	18848-8257
Country	:	US
Telephone Number	:	570-265-0100
Fax Number	:	570-265-6741

Provider Business Practice Location Address
First Line	:	1550 S MAIN ST STE 2
Second Line	:
City	:	MANSFIELD
State	:	PA
Zip	:	16933-9586
Country	:	US
Telephone Number	:	570-662-7954
Fax Number	:	570-662-7753

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

Provider Enumeration Date	:	10/09/2017
Last Update Date	:	03/17/2018

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Directions to “ EMILY NICHOLS LSW” Practice Location

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