Healthcare Provider Details

I. General information

NPI: 1639166929
Provider Name (Legal Business Name): HARVEY CURTIS NICHOLSON III PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: CURT NICHOLSON PH.D.

II. Dates (important events)

Enumeration Date: 10/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 E MAIN ST
LITITZ PA
17543-1941
US

IV. Provider business mailing address

57 E MAIN ST
LITITZ PA
17543-1941
US

V. Phone/Fax

Practice location:
  • Phone: 717-627-2857
  • Fax: 717-627-4455
Mailing address:
  • Phone: 717-627-2857
  • Fax: 717-627-4455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS-004493-L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierPS-004493-L
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPSYCHOLOGY LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: