Individual
MS. CAROL J SUTHERLAND NICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW BCD
Contact information
Practice address
915 ROUTE 28, HARWICH, MA 02645-3448
(508) 432-5640
(508) 432-5659
Mailing address
PO BOX 563, NORTH CHATHAM, MA 02650-0563
(508) 432-5640
(508) 432-5659
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
1023047
MA
104100000X
Social Worker
Primary
1023047
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
184437000
MAGELLAN
—
01
—
1890743
MBHP
—
01
—
762332
TUFTS
—
01
—
P06795
BCBS
—
Enumeration date
12/06/2005
Last updated
02/03/2009
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