Provider Demographics
NPI:1417109679
Name:TILLER, NATHAN PATRICK (BSW)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:PATRICK
Last Name:TILLER
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 LONG POND RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2662
Mailing Address - Country:US
Mailing Address - Phone:508-746-5632
Mailing Address - Fax:
Practice Address - Street 1:7 RANTOUL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-4885
Practice Address - Country:US
Practice Address - Phone:978-927-9410
Practice Address - Fax:978-922-6141
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor