Provider Demographics
NPI:1497069611
Name:TRIPP, NANCY ANN (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:TRIPP
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WOODS POND DR
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-1268
Mailing Address - Country:US
Mailing Address - Phone:978-799-8467
Mailing Address - Fax:
Practice Address - Street 1:41 E PRESCOTT ST
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-2355
Practice Address - Country:US
Practice Address - Phone:978-799-8467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1152781041C0700X
MA4180951041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool