Individual
LISA L NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
29 ELM ST, BRATTLEBORO, VT 05301-6511
(802) 254-7511
(802) 254-7506
Mailing address
1 HOSPITAL CT, STE 410, BELLOWS FALLS, VT 05101-1489
(802) 463-3294
(802) 463-1206
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
089-0000699
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2158213
CIGNA
VT
01
—
49345
BLUE CROSS
VT
05
—
OVN2757
—
VT
Enumeration date
03/26/2007
Last updated
07/08/2007
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