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Individual
LARISSA F NICKSON
Active
Individual
LARISSA F NICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
44SC05537000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31-4011
MEDICARE
NJ
05
—
4144007
—
NJ
Enumeration date
08/24/2010
Last updated
08/01/2023
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