Provider Demographics
NPI:1083926547
Name:DUMITRASCU, NICOLAE (PHD)
Entity Type:Individual
Prefix:
First Name:NICOLAE
Middle Name:
Last Name:DUMITRASCU
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 BRADFORD RD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-1217
Mailing Address - Country:US
Mailing Address - Phone:617-407-0276
Mailing Address - Fax:
Practice Address - Street 1:126 HARVARD ST STE 3
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-6473
Practice Address - Country:US
Practice Address - Phone:617-407-0276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9738103TC0700X
103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical