Provider Demographics
NPI:1720788029
Name:POPE, NANCY (LADC II)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:POPE
Suffix:
Gender:F
Credentials:LADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-5546
Mailing Address - Country:US
Mailing Address - Phone:508-345-7602
Mailing Address - Fax:
Practice Address - Street 1:29 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-5546
Practice Address - Country:US
Practice Address - Phone:508-345-7602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2294101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)