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NPI Code Detail

MEDICARE: NICOLE DESABRAIS LICSW

MEDICARE:   NICOLE  DESABRAIS  LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker114722MA

General Provider Information

NPI Number : 1417431156
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE DESABRAIS LICSW
Provider Business Mailing Address
First Line : 150 OLD PALMER RD
Second Line :
City : BRIMFIELD
State : MA
Zip : 01010-2130
Country : US
Telephone Number : 413-245-4377
Fax Number :
Provider Business Practice Location Address
First Line : 1369 GRAFTON ST
Second Line :
City : WORCESTER
State : MA
Zip : 01604-2737
Country : US
Telephone Number : 508-373-7400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2018
Last Update Date : 09/19/2018

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Directions to “ NICOLE DESABRAIS LICSW” Practice Location

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