Healthcare Provider Details

I. General information

NPI: 1205149754
Provider Name (Legal Business Name): COREY JOSEPH NIGRO PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 ENTERPRISE ST
DUXBURY MA
02332-3302
US

IV. Provider business mailing address

142 ENTERPRISE ST
DUXBURY MA
02332-3302
US

V. Phone/Fax

Practice location:
  • Phone: 617-750-9411
  • Fax:
Mailing address:
  • Phone: 617-750-9411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number9880
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: