MEDICARE: DR. NIA FAITH NICKS PHD LMSW

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	104100000X	Social Worker	15682

General Provider Information

NPI Number	:	1417806696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIA FAITH NICKS PHD LMSW

Provider Business Mailing Address
First Line	:	4334 MITHRA ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70126-2341
Country	:	US
Telephone Number	:	504-303-9512
Fax Number	:

Provider Business Practice Location Address
First Line	:	4334 MITHRA ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70126-2341
Country	:	US
Telephone Number	:	504-303-9512
Fax Number	:

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

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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