Healthcare Provider Details

I. General information

NPI: 1902302417
Provider Name (Legal Business Name): NANCY LOUISE PRESENT-VANBROEKHOVEN MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: N. PRESENT VANBROEKHOVEN LICSW

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 WINDING RIVER ROAD
NEEDHAM MA
02492-1025
US

IV. Provider business mailing address

70 WINDING RIVER ROAD
NEEDHAM MA
02492-1025
US

V. Phone/Fax

Practice location:
  • Phone: 781-239-0374
  • Fax:
Mailing address:
  • Phone: 781-239-0374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101828
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: