Provider Demographics
NPI:1760570634
Name:NAZAROFF, NANCY J (LICSW MSW MED)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:NAZAROFF
Suffix:
Gender:F
Credentials:LICSW MSW MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CUMMINGS CTR
Mailing Address - Street 2:SUITE 307L
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6115
Mailing Address - Country:US
Mailing Address - Phone:978-922-3301
Mailing Address - Fax:978-927-8556
Practice Address - Street 1:100 CUMMINGS CTR
Practice Address - Street 2:SUITE 307L
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6115
Practice Address - Country:US
Practice Address - Phone:978-922-3301
Practice Address - Fax:978-927-8556
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10231251041C0700X
NH12451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP06739Medicare ID - Type Unspecified