Healthcare Provider Details

I. General information

NPI: 1184377657
Provider Name (Legal Business Name): JOSHUA NICE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 11/20/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 EDEN RD
LANCASTER PA
17601-4713
US

IV. Provider business mailing address

229 JACKSON ST
LANCASTER PA
17603-2707
US

V. Phone/Fax

Practice location:
  • Phone: 717-462-7003
  • Fax:
Mailing address:
  • Phone: 717-598-5539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW024640
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: