Provider Demographics
NPI:1801962832
Name:NANNICELLI, PAULA B (LICSW)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:B
Last Name:NANNICELLI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:PAULA
Other - Middle Name:J
Other - Last Name:BEEBE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:8 WASHINGTON PLACE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184
Mailing Address - Country:US
Mailing Address - Phone:781-848-2131
Mailing Address - Fax:781-762-4533
Practice Address - Street 1:8 WASHINGTON PLACE
Practice Address - Street 2:SUITE 105
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184
Practice Address - Country:US
Practice Address - Phone:781-848-2131
Practice Address - Fax:781-762-4533
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1007381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAO03385OtherBCBS
MA44827OtherMAGELLAN
MA006469OtherHARVARD PILGRIM
MA44827OtherMAGELLAN