Individual
JACOB NICHOLLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
519 HERITAGE RD STE 2A5, SOUTHBURY, CT 06488-6694
(203) 568-5923
Mailing address
11 LINRON DR, DANBURY, CT 06810-6409
(203) 628-3508
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
13366
CT
Other
Enumeration date
09/21/2023
Last updated
09/21/2023
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