Provider Demographics
NPI:1184614612
Name:NISENBAUM, STEVEN (PHD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:NISENBAUM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 PERKINS ROW
Mailing Address - Street 2:
Mailing Address - City:TOPSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01983-1908
Mailing Address - Country:US
Mailing Address - Phone:978-887-6606
Mailing Address - Fax:530-484-2554
Practice Address - Street 1:166 PERKINS ROW
Practice Address - Street 2:
Practice Address - City:TOPSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01983-1908
Practice Address - Country:US
Practice Address - Phone:978-887-6606
Practice Address - Fax:530-484-2554
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3670103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist