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NPI Code Detail

MEDICARE: EMMELE NICHOLAS MSW, LCSW

MEDICARE:   EMMELE  NICHOLAS  MSW, 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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1871836874
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMMELE NICHOLAS MSW, LCSW
Provider Business Mailing Address
First Line : 212 E MONUMENT ST
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80903-1004
Country : US
Telephone Number : 719-447-0370
Fax Number :
Provider Business Practice Location Address
First Line : 212 E MONUMENT ST
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80903-1004
Country : US
Telephone Number : 719-447-0370
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2013
Last Update Date : 08/15/2014

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Directions to “ EMMELE NICHOLAS MSW, LCSW” Practice Location

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