Healthcare Provider Details

I. General information

NPI: 1578840005
Provider Name (Legal Business Name): AARON NICOLAIDES LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2011
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5742 ADAMS AVE PKWY STE C
OGDEN UT
84405-7158
US

IV. Provider business mailing address

5742 ADAMS AVE PKWY STE C
OGDEN UT
84405-7158
US

V. Phone/Fax

Practice location:
  • Phone: 385-250-3314
  • Fax:
Mailing address:
  • Phone: 385-250-3314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5955-C
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5962187-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: