Healthcare Provider Details

I. General information

NPI: 1316168800
Provider Name (Legal Business Name): ELIZABETH ANN NICHOLAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SPRING ST #110
SILVER SPRING MD
20910-4022
US

IV. Provider business mailing address

1001 SPRING ST #110
SILVER SPRING MD
20910-4022
US

V. Phone/Fax

Practice location:
  • Phone: 301-495-9523
  • Fax: 301-587-0217
Mailing address:
  • Phone: 301-495-9523
  • Fax: 301-587-0217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2776
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: