Healthcare Provider Details

I. General information

NPI: 1821319922
Provider Name (Legal Business Name): NATHANIEL PIKE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2010
Last Update Date: 06/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 MAIN ST STE 401
SPRINGFIELD MA
01103-1348
US

IV. Provider business mailing address

1695 MAIN ST STE 401
SPRINGFIELD MA
01103-1348
US

V. Phone/Fax

Practice location:
  • Phone: 413-739-5572
  • Fax: 413-739-9972
Mailing address:
  • Phone: 413-739-5572
  • Fax: 413-739-9972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number213160
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: