Provider Demographics
NPI:1407983604
Name:AMISANO, PHILIP GUY (RN BSN CMT)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:GUY
Last Name:AMISANO
Suffix:
Gender:M
Credentials:RN BSN CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HALL AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2003
Mailing Address - Country:US
Mailing Address - Phone:617-623-3278
Mailing Address - Fax:617-623-1332
Practice Address - Street 1:5 HALL AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2003
Practice Address - Country:US
Practice Address - Phone:617-623-3278
Practice Address - Fax:617-623-1332
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA168148163WA0400X, 163WD0400X, 163WG0000X, 163WM1400X, 163WP0807X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
Not Answered163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Not Answered163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Not Answered163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
Not Answered163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Not Answered163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health