Provider Demographics
NPI:1184382095
Name:ALTIERI, NICOLE S (LCSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:S
Last Name:ALTIERI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01966-2116
Mailing Address - Country:US
Mailing Address - Phone:617-359-2603
Mailing Address - Fax:
Practice Address - Street 1:100 CUMMINGS CTR STE 158D
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6279
Practice Address - Country:US
Practice Address - Phone:617-359-2603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2236401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical