Healthcare Provider Details

I. General information

NPI: 1609930171
Provider Name (Legal Business Name): JESSICA MARIE NUHIBIAN BOISVERT MSW, LCSW, CEIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 DIMOCK ST
ROXBURY MA
02119-1029
US

IV. Provider business mailing address

15 RUSSELL RD
DEDHAM MA
02026-3311
US

V. Phone/Fax

Practice location:
  • Phone: 617-442-8800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2032731
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: