Provider Demographics
NPI:1649363474
Name:NAGEL, NANCY M (LICSW)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:M
Last Name:NAGEL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 WARREN ST
Mailing Address - Street 2:BLDG 1
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3601
Mailing Address - Country:US
Mailing Address - Phone:617-787-4662
Mailing Address - Fax:617-787-8017
Practice Address - Street 1:77 WARREN ST
Practice Address - Street 2:BLDG. 1
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3601
Practice Address - Country:US
Practice Address - Phone:617-787-4662
Practice Address - Fax:617-787-8017
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2016-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1076791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA006460OtherPACIFICARE
MABLUE CROSS BLUE SHIEOtherP07169
MAS300283901OtherMEDICARE PTAN
MA779692OtherTUFTS
MAHMO/MAGELLANOther106398
MAHMO/MAGELLANOther106398