Provider Demographics
NPI:1306257316
Name:NICHOLSON, AMY (LCSW-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11350 MCCORMICK RD STE 800
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1002
Mailing Address - Country:US
Mailing Address - Phone:410-800-2169
Mailing Address - Fax:
Practice Address - Street 1:11350 MCCORMICK RD STE 800
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-1002
Practice Address - Country:US
Practice Address - Phone:410-800-2169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD142131041C0700X
DEQ1-00122541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD609550001Medicaid
MD7840093OtherAETNA
MD259147-000OtherMAGELLAN BEHAVIORAL HEALTH
MD346646OtherMHN
MDLM49EAOtherCAREFIRST OF MARYLAND
MDR968OtherCAREFIRST FEDERAL
MD742LMedicare PIN