Provider Demographics
NPI:1396931374
Name:NAZZARO, ADRIENNE (CAGS)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:NAZZARO
Suffix:
Gender:F
Credentials:CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 BROOKVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BOXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01921-2216
Mailing Address - Country:US
Mailing Address - Phone:978-502-4499
Mailing Address - Fax:
Practice Address - Street 1:42 BROOKVIEW RD
Practice Address - Street 2:
Practice Address - City:BOXFORD
Practice Address - State:MA
Practice Address - Zip Code:01921-2216
Practice Address - Country:US
Practice Address - Phone:978-502-4499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA332160101YS0200X
MA966103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0584495Medicaid