Provider Demographics
NPI:1578631586
Name:NORDSTROM, BARBARA MAE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:MAE
Last Name:NORDSTROM
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ANGELL BROOK DR
Mailing Address - Street 2:
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-2117
Mailing Address - Country:US
Mailing Address - Phone:774-261-8473
Mailing Address - Fax:
Practice Address - Street 1:21 ANGELL BROOK DR
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-2117
Practice Address - Country:US
Practice Address - Phone:774-261-8473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10254561041C0700X
MA1025456LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical