1619693140 NPI number — NAKISHA PARILLON LICSW LLC

Table of content: (NPI 1619693140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619693140 NPI number — NAKISHA PARILLON LICSW LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NAKISHA PARILLON LICSW LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619693140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 MASS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROCKTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02302-2539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-283-0654
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 WESTGATE DR # 1051
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROCKTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02301-1855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-283-0654
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PARILLON
Authorized Official First Name:
NAKISHA
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR CLINICIAN
Authorized Official Telephone Number:
617-283-0654

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1205354776 . This is a "NPI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".