MEDICARE: NICHOLAS DAVID CHIGNOLI 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	SWB-2026-0250	NM

General Provider Information

NPI Number	:	1629900527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS DAVID CHIGNOLI LMSW

Provider Business Mailing Address
First Line	:	1660 OLD PECOS TRL # A
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-4779
Country	:	US
Telephone Number	:	505-548-9023
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 OLD PECOS TRL # A
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-4779
Country	:	US
Telephone Number	:	505-548-9023
Fax Number	:

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

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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