Provider Demographics
NPI:1073743860
Name:CONOVER, NICOLE JEANNE (BA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:JEANNE
Last Name:CONOVER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-1467
Mailing Address - Country:US
Mailing Address - Phone:781-255-1817
Mailing Address - Fax:
Practice Address - Street 1:275 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-1467
Practice Address - Country:US
Practice Address - Phone:781-255-1817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor