Provider Demographics
NPI:1932555497
Name:NICOLAS, ANNE
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:NICOLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 BLUE HILL AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-2114
Mailing Address - Country:US
Mailing Address - Phone:857-598-4774
Mailing Address - Fax:857-598-4816
Practice Address - Street 1:1613 BLUE HILL AVE STE 302
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126
Practice Address - Country:US
Practice Address - Phone:857-598-4774
Practice Address - Fax:857-598-4816
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health