Eric Charles Nichols, PH.D.
Individual provider Active NPI Psychologist · Burlington, VT
NPI 1265584601 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1265584601
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 048-0000330 (VT)
- Practice address
- 156 College St
Burlington, VT 05401-8423 - Phone
- (802) 578-9855
- NPI assigned
- Jan 17, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
5450 Macdonald Ave
Suite 5
Key West, FL 33040-5906
Phone (305) 294-2343
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080317000161 | FL | Practitioner - Clinical Psychologist | 2062592595 | Practice locations: Key West, FL |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 048-0000330 | VT | MD | Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 048-0000330 | VT | Yes |
Addresses
Primary practice location
156 College St
Burlington, VT 05401-8423
Mailing address
156 College St
Burlington, VT 05401-8423
Phone (802) 578-9855
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1005516 | Medicaid | VT |
Other providers in Burlington, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.