Provider Demographics
NPI:1639609563
Name:NIELSEN, PHILIPPA (LMHC)
Entity Type:Individual
Prefix:
First Name:PHILIPPA
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:PIP
Other - Middle Name:
Other - Last Name:NIELSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:46 JERSEY ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-2414
Mailing Address - Country:US
Mailing Address - Phone:781-526-8958
Mailing Address - Fax:
Practice Address - Street 1:100 CUMMINGS CTR STE 456J
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6132
Practice Address - Country:US
Practice Address - Phone:978-921-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10145101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health