Provider Demographics
NPI:1154620920
Name:NICHOLAS, CHERYL E (HS-BCP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:E
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:HS-BCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 DUKE ST
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-3150
Mailing Address - Country:US
Mailing Address - Phone:617-921-8364
Mailing Address - Fax:617-298-2188
Practice Address - Street 1:37 DUKE ST
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-3150
Practice Address - Country:US
Practice Address - Phone:617-921-8364
Practice Address - Fax:617-298-2188
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-19
Last Update Date:2011-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service