Provider Demographics
NPI:1508099128
Name:NAZAIRE, JUDITH (LICENSED SOCIAL WORK)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:NAZAIRE
Suffix:
Gender:F
Credentials:LICENSED SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 OAK ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1355
Mailing Address - Country:US
Mailing Address - Phone:508-583-2428
Mailing Address - Fax:
Practice Address - Street 1:137 OAK ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1355
Practice Address - Country:US
Practice Address - Phone:508-583-2428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-30
Last Update Date:2009-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA313509101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health