Provider Demographics
NPI:1295096642
Name:PUROL, NICHOLAS (LICSW)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:PUROL
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 HIGHLAND AVE
Mailing Address - Street 2:APT. 1
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-1515
Mailing Address - Country:US
Mailing Address - Phone:502-777-2396
Mailing Address - Fax:
Practice Address - Street 1:195 HIGHLAND AVE
Practice Address - Street 2:APT. 1
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-1515
Practice Address - Country:US
Practice Address - Phone:502-777-2396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1179461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical