Healthcare Provider Details

I. General information

NPI: 1366364804
Provider Name (Legal Business Name): NIXIN PANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 HANCOCK ST STE 306
QUINCY MA
02169-5236
US

IV. Provider business mailing address

1505 COMMONWEALTH AVE UNIT 313
BRIGHTON MA
02135-3626
US

V. Phone/Fax

Practice location:
  • Phone: 617-404-3621
  • Fax:
Mailing address:
  • Phone:
  • 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: