Provider Demographics
NPI:1730432568
Name:MOSCATELLI, NICOLE SUZANNE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:SUZANNE
Last Name:MOSCATELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 UPHAM RD
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-1816
Mailing Address - Country:US
Mailing Address - Phone:781-584-0489
Mailing Address - Fax:
Practice Address - Street 1:21 UPHAM RD
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-1816
Practice Address - Country:US
Practice Address - Phone:781-584-0489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical