Healthcare Provider Details

I. General information

NPI: 1366021370
Provider Name (Legal Business Name): NICOLE CURTIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 ELM ST
WORCESTER MA
01609-2362
US

IV. Provider business mailing address

3 SHADY AVE
WESTMINSTER MA
01473-1319
US

V. Phone/Fax

Practice location:
  • Phone: 774-367-3374
  • Fax:
Mailing address:
  • Phone: 978-434-1340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number127923
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number226371
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: