Provider Demographics
NPI:1649355207
Name:TOMB, NANCY C (MSW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:C
Last Name:TOMB
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 1:1 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03064-2716
Mailing Address - Country:US
Mailing Address - Phone:508-831-9890
Mailing Address - Fax:508-831-9890
Practice Address - Street 1:34 CEDAR ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2560
Practice Address - Country:US
Practice Address - Phone:508-831-9890
Practice Address - Fax:508-831-9890
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10284391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP20617Medicare ID - Type Unspecified