Healthcare Provider Details

I. General information

NPI: 1801011002
Provider Name (Legal Business Name): JULIA VALIN NISS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 04/19/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 LOWELL ST STE B7
WILMINGTON MA
01887-3073
US

IV. Provider business mailing address

226 LOWELL ST STE B7
WILMINGTON MA
01887-3073
US

V. Phone/Fax

Practice location:
  • Phone: 781-208-0558
  • Fax: 781-208-0558
Mailing address:
  • Phone: 781-208-0558
  • Fax: 781-208-0558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114470
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: