Healthcare Provider Details

I. General information

NPI: 1730209297
Provider Name (Legal Business Name): NANCY A. TOPPING-TAILBY L.I.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 BEACON ST
BROOKLINE MA
02446-4816
US

IV. Provider business mailing address

54 STEWART RD
NEEDHAM MA
02492-1120
US

V. Phone/Fax

Practice location:
  • Phone: 617-566-2200
  • Fax: 617-278-0200
Mailing address:
  • Phone: 781-449-2361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100570
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: