Healthcare Provider Details

I. General information

NPI: 1477999894
Provider Name (Legal Business Name): CHRISTINA NICOLAU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145K FAUNCE CORNER ROAD
NORTH DARTMOUTH MA
02747
US

IV. Provider business mailing address

130 ROCKLAND STREET APARTMENT 1
NEW BEDFORD MA
02740
US

V. Phone/Fax

Practice location:
  • Phone: 774-206-1125
  • Fax: 774-628-9657
Mailing address:
  • Phone: 774-955-2665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: