Provider Demographics
NPI:1588082515
Name:TRIETSCH, NICHOLAS (LICSW)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:TRIETSCH
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 W MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2310
Mailing Address - Country:US
Mailing Address - Phone:301-792-1081
Mailing Address - Fax:
Practice Address - Street 1:142 N QUEEN ST STE 105
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3312
Practice Address - Country:US
Practice Address - Phone:304-579-1515
Practice Address - Fax:304-254-6206
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00944163104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker