Provider Demographics
NPI:1649337387
Name:TREVINO, NANCY JANE (MSW)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:JANE
Last Name:TREVINO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 BURT STREET
Mailing Address - Street 2:UNIT 1
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-2524
Mailing Address - Country:US
Mailing Address - Phone:508-838-0754
Mailing Address - Fax:
Practice Address - Street 1:604 FOUNDRY STREET
Practice Address - Street 2:
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375
Practice Address - Country:US
Practice Address - Phone:508-838-0754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASW107726101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1857631Medicaid
MAP21203Medicare ID - Type Unspecified