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General NPI Number Information
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NPI Number | 1558842385
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Entity Type | Individual
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Provider Name | KIMBERLY SUSAN NICHOLS
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Gender | Female
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Dates
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Enumeration Date | 08/29/2018
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Last Update Date | 08/29/2018
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Provider Practice Location Address
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Address Line | 228 BILLERICA RD
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City | CHELMSFORD
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State | MA
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Zip | 01824-3604
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Country | US
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Telephone | 978-977-4496
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Fax | 617-421-2632
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Provider Business Mailing Address
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Address Line | 600 VARNUM AVE
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City | LOWELL
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State | MA
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Zip | 01854-2126
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Country | US
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Telephone | 978-726-1410
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Fax | 617-421-2632
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 119322
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License Number State | MA
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