Provider Demographics
NPI:1134426406
Name:DRURY, NICOLE A (MS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:DRURY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 NORMAN ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-5003
Mailing Address - Country:US
Mailing Address - Phone:413-736-8329
Mailing Address - Fax:413-732-5362
Practice Address - Street 1:25 MOORELAND ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-1826
Practice Address - Country:US
Practice Address - Phone:413-785-5851
Practice Address - Fax:413-785-5854
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303295 (MH)Medicaid
M18463OtherBC / BS
MA1307756Medicaid
MA1307756Medicaid