| Doctor Name: | MARK NICKELS |
| NPI Number: | 1124429840 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 96 South St Ware Ware, MA - 010821616 |
| Business Phone Number: | 4139676241 |
| Business Fax Number: | |
| Mailing Address: | 96 South St, Ware WARE |
| State: | MA |
| Postal Code: | 010821616 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/12/2014 |
| NPI Last Update Date: | 09/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |