Healthcare Provider Details

I. General information

NPI: 1952473647
Provider Name (Legal Business Name): JOHN ARTHUR NICHOLS PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 BELMONT ST
BELMONT MA
02478-3603
US

IV. Provider business mailing address

4 RUMFORD RD
LEXINGTON MA
02420-2209
US

V. Phone/Fax

Practice location:
  • Phone: 617-484-1042
  • Fax:
Mailing address:
  • Phone: 617-484-1042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4101
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4101
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: