Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YS0200X | School Counselor | 446427 | MA |
NPI | 1124770763 |
---|---|
Provider Name | Laura Kathleen Nicholson |
First Address | Mansfield, MA 02048-2057 |
Second Address | Taunton, MA 02780-3243 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2022 |
Last Update Date | 25/01/2022 |