Provider Demographics
NPI:1326390816
Name:FORTI, NICK (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NICK
Middle Name:
Last Name:FORTI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 HIGHLAND AVE # 1009
Mailing Address - Street 2:
Mailing Address - City:SEEKONK
Mailing Address - State:MA
Mailing Address - Zip Code:02771-5818
Mailing Address - Country:US
Mailing Address - Phone:781-609-7916
Mailing Address - Fax:
Practice Address - Street 1:40 CRESCENT ST STE 102
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-4313
Practice Address - Country:US
Practice Address - Phone:781-609-7916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9842103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9842OtherSTATE LICENSE