Provider Demographics
NPI:1720571540
Name:NICHOLSON, CODY LEE (LMHC)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:LEE
Last Name:NICHOLSON
Suffix:
Gender:
Credentials:LMHC
Other - Prefix:
Other - First Name:CODY
Other - Middle Name:LEE
Other - Last Name:KUCHARSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:P.O. BOX 698
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324
Mailing Address - Country:US
Mailing Address - Phone:857-245-9099
Mailing Address - Fax:
Practice Address - Street 1:169 BROAD STREET
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324
Practice Address - Country:US
Practice Address - Phone:857-245-9099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MALMHC11952101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health