Provider Demographics
NPI:1194790584
Name:WEST, NICHOL JO (LCSW)
Entity type:Individual
Prefix:MISS
First Name:NICHOL
Middle Name:JO
Last Name:WEST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 LEDGEWOOD RD
Mailing Address - Street 2:APT 206
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-6618
Mailing Address - Country:US
Mailing Address - Phone:724-322-3399
Mailing Address - Fax:
Practice Address - Street 1:187 LEDGEWOOD RD
Practice Address - Street 2:APT 206
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-6618
Practice Address - Country:US
Practice Address - Phone:724-322-3399
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0147111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical