Healthcare Provider Details

I. General information

NPI: 1164713715
Provider Name (Legal Business Name): NICHOLAS MICHAEL ESPOSITO LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 COMMONWEALTH AVE STE R
BOSTON MA
02215
US

IV. Provider business mailing address

870 COMMONWEALTH AVE STE R
BOSTON MA
02215-1233
US

V. Phone/Fax

Practice location:
  • Phone: 617-278-6380
  • Fax: 617-278-6386
Mailing address:
  • Phone: 617-278-6380
  • Fax: 617-278-6386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number118170
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: