Individual
STEFAN NICKUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
3993 VT ROUTE 100, GRANVILLE, VT 05747-9747
(206) 818-2439
Mailing address
3993 VT ROUTE 100, GRANVILLE, VT 05747-9747
(206) 818-2439
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
089.0134493
VT
Other
Enumeration date
06/11/2024
Last updated
06/11/2024
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