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General NPI Number Information
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NPI Number | 1952473647
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Entity Type | Individual
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Provider Name | JOHN ARTHUR NICHOLS PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 03/30/2010
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Provider Practice Location Address
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Address Line | 113 BELMONT ST
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City | BELMONT
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State | MA
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Zip | 02478-3603
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Country | US
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Telephone | 617-484-1042
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Fax |
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Provider Business Mailing Address
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Address Line | 4 RUMFORD RD
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City | LEXINGTON
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State | MA
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Zip | 02420-2209
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Country | US
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Telephone | 617-484-1042
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4101
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 4101
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License Number State | MA
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