Provider Demographics
NPI:1154049039
Name:CIRINO, NISHA MARIE (LICSW)
Entity type:Individual
Prefix:
First Name:NISHA
Middle Name:MARIE
Last Name:CIRINO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:NISHA
Other - Middle Name:M
Other - Last Name:CIRINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:650 HUNTINGTON AVE APT 17J
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5909
Mailing Address - Country:US
Mailing Address - Phone:857-399-3066
Mailing Address - Fax:
Practice Address - Street 1:640 CENTRE ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2555
Practice Address - Country:US
Practice Address - Phone:617-983-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225648104100000X
MA1258231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker