Provider Demographics
NPI:1295152825
Name:NOZOLINO, BRITTANY JO
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:JO
Last Name:NOZOLINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 BEALE ST APT 201
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-2655
Mailing Address - Country:US
Mailing Address - Phone:617-981-1393
Mailing Address - Fax:
Practice Address - Street 1:17 INNERBELT RD
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-4418
Practice Address - Country:US
Practice Address - Phone:617-981-1393
Practice Address - Fax:617-629-0010
Is Sole Proprietor?:No
Enumeration Date:2014-03-20
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAIN PROGRESS390200000X
MA1726106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1726OtherMA DIVISION OF PROFESSIONAL LICENSURE BOARD OF ALLIED MENTAL HEALTH