Provider Demographics
NPI:1780787911
Name:NICKDOW, DONNA (LCSW)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:NICKDOW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 PURDY HILL RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2215
Mailing Address - Country:US
Mailing Address - Phone:203-924-9426
Mailing Address - Fax:203-924-9426
Practice Address - Street 1:205 WAKELEE AVE
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-1234
Practice Address - Country:US
Practice Address - Phone:203-735-7481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0035801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT140003580CT01OtherBLUE CROSS