Provider Demographics
NPI:1023353224
Name:ERNST, NICHOLAS (LCSW)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:ERNST
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 DEER HILL RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:ME
Mailing Address - Zip Code:04037-3100
Mailing Address - Country:US
Mailing Address - Phone:207-697-2020
Mailing Address - Fax:206-697-2021
Practice Address - Street 1:69 DEER HILL RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:ME
Practice Address - Zip Code:04037-3100
Practice Address - Country:US
Practice Address - Phone:207-697-2020
Practice Address - Fax:206-697-2021
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC126371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical