Healthcare Provider Details

I. General information

NPI: 1063574770
Provider Name (Legal Business Name): NANCY B. LAX MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2006
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 AYER RD SUITE 204
HARVARD MA
01451-1133
US

IV. Provider business mailing address

249 AYER RD SUITE 204
HARVARD MA
01451-1133
US

V. Phone/Fax

Practice location:
  • Phone: 978-772-6100
  • Fax: 978-772-6980
Mailing address:
  • Phone: 978-772-6100
  • Fax: 978-772-6980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104752
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: