MEDICARE: NICOLE TSCHOPP LCSW-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2304898	OH
2	1041C0700X	Clinical Social Worker	13280	MD

General Provider Information

NPI Number	:	1053606632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE TSCHOPP LCSW-C

Provider Business Mailing Address
First Line	:	380 FOREST ST APT E
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43206-2255
Country	:	US
Telephone Number	:	443-801-6556
Fax Number	:

Provider Business Practice Location Address
First Line	:	380 FOREST ST APT E
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43206-2255
Country	:	US
Telephone Number	:	443-801-6556
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2011
Last Update Date	:	11/02/2023

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