Healthcare Provider Details

I. General information

NPI: 1497746481
Provider Name (Legal Business Name): BRENDA R NICKERSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMMUNITY COUNCIL 440 AMHERST STREET
NASHUA NH
03063-3147
US

IV. Provider business mailing address

3531 PINE TREE CT
GREENACRES FL
33463-3147
US

V. Phone/Fax

Practice location:
  • Phone: 603-889-6147
  • Fax:
Mailing address:
  • Phone: 561-629-8266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: