Healthcare Provider Details

I. General information

NPI: 1679575732
Provider Name (Legal Business Name): JACQUELINE FEMINO-NICOLL LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 GREEN ST
NEWBURY MA
01951-1721
US

IV. Provider business mailing address

28 GREEN ST
NEWBURY MA
01951-1721
US

V. Phone/Fax

Practice location:
  • Phone: 978-463-0463
  • Fax: 978-499-2177
Mailing address:
  • Phone: 978-463-0463
  • Fax: 978-499-2177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1026541
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: