Provider Demographics
NPI:1356594204
Name:LYNNE EDGECOMB-NICKESON, LICSW, PLLC
Entity type:Organization
Organization Name:LYNNE EDGECOMB-NICKESON, LICSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDGECOMB-NICKESON,
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:603-490-8723
Mailing Address - Street 1:15 ELMER RD
Mailing Address - Street 2:SU 208A
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-1271
Mailing Address - Country:US
Mailing Address - Phone:603-490-8723
Mailing Address - Fax:
Practice Address - Street 1:15 ERMER RD
Practice Address - Street 2:SU 208A
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-1271
Practice Address - Country:US
Practice Address - Phone:603-490-8723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty