Provider Demographics
NPI:1366288656
Name:NICHOLSON, AMY L (LMSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N BROAD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1045
Mailing Address - Country:US
Mailing Address - Phone:302-519-0363
Mailing Address - Fax:
Practice Address - Street 1:115 N BROAD ST STE 1
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1045
Practice Address - Country:US
Practice Address - Phone:302-519-0363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ3-0011409104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker