Provider Demographics
NPI:1154670248
Name:NAZZIWA, ANNETTE KAZIBWE (LICSW)
Entity Type:Individual
Prefix:
First Name:ANNETTE KAZIBWE
Middle Name:
Last Name:NAZZIWA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 DIMOCK ST
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1210
Mailing Address - Country:US
Mailing Address - Phone:617-989-2938
Mailing Address - Fax:617-445-9147
Practice Address - Street 1:30 DIMOCK ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119
Practice Address - Country:US
Practice Address - Phone:617-989-2938
Practice Address - Fax:617-445-9147
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1208011041C0700X
MA2180691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical