Provider Demographics
NPI:1114250511
Name:MCNEIL, NICOLE LEE (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEE
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LEE
Other - Last Name:FRANCIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:44 MASON RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:NH
Mailing Address - Zip Code:03033
Mailing Address - Country:US
Mailing Address - Phone:617-610-3402
Mailing Address - Fax:
Practice Address - Street 1:44 MASON RD
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:NH
Practice Address - Zip Code:03033
Practice Address - Country:US
Practice Address - Phone:617-610-3402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1171701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110113739AMedicaid