| Doctor Name: | MRS. MARY ELLEN FORRESTALL-NICHOLLS |
| NPI Number: | 1558458448 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LICSW BCD |
| License Number: | 117 |
| Business Practice Address: | 66 Bow Bog Rd Bow, NH - 033044304 |
| Business Phone Number: | 6032257770 |
| Business Fax Number: | |
| Mailing Address: | 66 Bow Bog Rd, BOW |
| State: | NH |
| Postal Code: | 033044304 |
| Phone Number: | 6032257770 |
| Fax Number: | |
| NPI Enumeration Date: | 10/10/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 117 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |