Provider Demographics
NPI:1639204118
Name:NIENTIMP, ERIN P (LCSW)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:P
Last Name:NIENTIMP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 COLLEGE PARK RD
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-7325
Mailing Address - Country:US
Mailing Address - Phone:508-678-0041
Mailing Address - Fax:
Practice Address - Street 1:178 PINE ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-2312
Practice Address - Country:US
Practice Address - Phone:508-678-0041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2108701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA685661OtherTUFTS
MAM18708OtherBLUE CROSS
MA1312677Medicaid
MA1312677Medicaid