Provider Demographics
NPI:1043691132
Name:NESTOR, COLLEEN (PSYD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:NESTOR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 441206
Mailing Address - Street 2:
Mailing Address - City:WEST SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-0010
Mailing Address - Country:US
Mailing Address - Phone:978-328-4514
Mailing Address - Fax:
Practice Address - Street 1:45 YERXA RD UNIT 201
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-2510
Practice Address - Country:US
Practice Address - Phone:978-328-4514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist