Provider Demographics
NPI:1184301467
Name:PRICKETT, NOAH
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:PRICKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAE
Other - Middle Name:
Other - Last Name:PRICKETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:38 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4604
Mailing Address - Country:US
Mailing Address - Phone:774-297-7975
Mailing Address - Fax:
Practice Address - Street 1:38 BROAD ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4604
Practice Address - Country:US
Practice Address - Phone:774-297-7975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator