Provider Demographics
NPI:1720168719
Name:NAGLE, ROBERTA ANN (LCSW LADAC1)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:ANN
Last Name:NAGLE
Suffix:
Gender:F
Credentials:LCSW LADAC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 LINCOLN STREET
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-854-3320
Mailing Address - Fax:508-753-5051
Practice Address - Street 1:585 LINCOLN STREET
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-854-3320
Practice Address - Fax:508-753-5051
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204233101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1308785OtherBCBS MH M18684
MA1306421Medicaid
MA2220002001OtherBCBS SUBSTANCE ABUSE
MA1308785OtherMEDICID MENTAL HEALTH
MAY10400Medicare ID - Type Unspecified