MEDICARE: EDWARD MCNICHOLS 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	CW019489	PA
2	1041C0700X	Clinical Social Worker	LCSW109626	CA

General Provider Information

NPI Number	:	1356877229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD MCNICHOLS LCSW

Provider Business Mailing Address
First Line	:	300 MULBERRY ST
Second Line	:	#201
City	:	SCRANTON
State	:	PA
Zip	:	18503-1225
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2071 ANTIOCH CT STE 201
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-2955
Country	:	US
Telephone Number	:	570-470-2981
Fax Number	:	570-504-0861

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

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	02/07/2026

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