Active NPI
Emily B Nichols, PHD
- Clinical Child & Adolescent Psychologist
- Fairfax, VA
National Provider Identifier
1275877607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 0810005751
- Practice address
- 3023 Hamaker CT Ste 300
Fairfax, VA 22031-2240 - Phone
- (703) 848-6627
- NPI assigned
- Nov 26, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | 0810005751 | VA | Primary |
Addresses
Primary practice location
3023 Hamaker CT Ste 300
Fairfax, VA 22031-2240
Mailing address
300 Longwood Ave
Boston, MA 02115-5724
Phone (617) 919-7837
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810005751 | VA | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1353888000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625702400000",
"number": "1275877607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 LONGWOOD AVE",
"city": "BOSTON",
"state": "MA",
"postal_code": "021155724",
"telephone_number": "617-919-7837"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3023 HAMAKER CT STE 300",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220312240",
"telephone_number": "703-848-6627"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "EMILY",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-11-26",
"last_updated": "2021-07-08",
"certification_date": "2021-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "VA",
"license": "0810005751",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.