Provider Demographics
NPI:1487984241
Name:PROTASENIA, NIKOLAS R (MASTERS)
Entity type:Individual
Prefix:MR
First Name:NIKOLAS
Middle Name:R
Last Name:PROTASENIA
Suffix:
Gender:M
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 DERBY ST
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4216
Mailing Address - Country:US
Mailing Address - Phone:732-762-5553
Mailing Address - Fax:
Practice Address - Street 1:99 DERBY ST
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4216
Practice Address - Country:US
Practice Address - Phone:732-762-5553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10450101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1487984241Medicaid