Provider Demographics
NPI:1164713715
Name:ESPOSITO, NICHOLAS MICHAEL (LICSW)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:MICHAEL
Last Name:ESPOSITO
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:870 COMMONWEALTH AVE STE R
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-1233
Mailing Address - Country:US
Mailing Address - Phone:617-278-6380
Mailing Address - Fax:617-278-6386
Practice Address - Street 1:870 COMMONWEALTH AVE STE R
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-278-6380
Practice Address - Fax:617-278-6386
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1181701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA23-1728027Medicaid