Healthcare Provider Details

I. General information

NPI: 1790959195
Provider Name (Legal Business Name): BEVERLY BEBE NIXON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

25 WAVERLY ST
BROOKLINE MA
02445-6833
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5656
  • Fax:
Mailing address:
  • Phone: 617-734-8315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number214667
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: