MEDICARE: ELIZABETH ANN NICHOLAS LCSW

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	2776	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24408	OTHER	MD	MAMSI
2	4354	OTHER	MD	CAREFIRST

General Provider Information

NPI Number	:	1316168800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANN NICHOLAS LCSW

Provider Business Mailing Address
First Line	:	1001 SPRING ST
Second Line	:	#110
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4022
Country	:	US
Telephone Number	:	301-495-9523
Fax Number	:	301-587-0217

Provider Business Practice Location Address
First Line	:	1001 SPRING ST
Second Line	:	#110
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4022
Country	:	US
Telephone Number	:	301-495-9523
Fax Number	:	301-587-0217

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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