Doctor Name: | NICHOLE ARTAVIA |
NPI Number: | 1073906020 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 540 Vfw Pkwy Suite 6 West Roxbury, MA - 021321332 |
Business Phone Number: | 6173252993 |
Business Fax Number: | 6173255618 |
Mailing Address: | 31 Blanchard Rd, CAMBRIDGE |
State: | MA |
Postal Code: | 021381010 |
Phone Number: | 6179454454 |
Fax Number: | |
NPI Enumeration Date: | 03/16/2015 |
NPI Last Update Date: | 03/16/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |