Provider Demographics
NPI:1437173432
Name:GILL, NANCY G (LICSW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:G
Last Name:GILL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 MIDDLESEX RD
Mailing Address - Street 2:#258
Mailing Address - City:TYNGSBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01879-1070
Mailing Address - Country:US
Mailing Address - Phone:978-413-7468
Mailing Address - Fax:978-649-6773
Practice Address - Street 1:319 LITTLETON ROAD
Practice Address - Street 2:SUITE 108
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-4126
Practice Address - Country:US
Practice Address - Phone:978-413-7468
Practice Address - Fax:978-649-6773
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1106101041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P22439Medicare UPIN