Provider Demographics
NPI:1619446010
Name:MARTIN, NANCY MASINO (LICSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:MASINO
Last Name:MARTIN
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:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:MA
Mailing Address - Zip Code:01245-0157
Mailing Address - Country:US
Mailing Address - Phone:413-528-1804
Mailing Address - Fax:413-645-1022
Practice Address - Street 1:100 GOULD RD.
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:MA
Practice Address - Zip Code:01245
Practice Address - Country:US
Practice Address - Phone:413-528-1804
Practice Address - Fax:413-645-1022
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1145681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty