Provider Demographics
NPI:1316168800
Name:NICHOLAS, ELIZABETH ANN (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:NICHOLAS
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 1:1001 SPRING ST
Mailing Address - Street 2:#110
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4022
Mailing Address - Country:US
Mailing Address - Phone:301-495-9523
Mailing Address - Fax:301-587-0217
Practice Address - Street 1:1001 SPRING ST
Practice Address - Street 2:#110
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4022
Practice Address - Country:US
Practice Address - Phone:301-495-9523
Practice Address - Fax:301-587-0217
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD24408OtherMAMSI
MD4354OtherCAREFIRST
MD24408OtherMAMSI