Provider Demographics
NPI:1568686558
Name:NIXON, MARY ELLEN (LMHC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:NIXON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 DONCASTER ST
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-4610
Mailing Address - Country:US
Mailing Address - Phone:617-323-6995
Mailing Address - Fax:
Practice Address - Street 1:38 DONCASTER ST
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-4610
Practice Address - Country:US
Practice Address - Phone:617-323-6995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5424101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)