Provider Demographics
NPI:1205149754
Name:NIGRO, COREY JOSEPH (PSYD)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:JOSEPH
Last Name:NIGRO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 ENTERPRISE ST
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-3302
Mailing Address - Country:US
Mailing Address - Phone:617-750-9411
Mailing Address - Fax:
Practice Address - Street 1:142 ENTERPRISE ST
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-3302
Practice Address - Country:US
Practice Address - Phone:617-750-9411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9880103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist