Provider Demographics
NPI:1083269153
Name:DINE, NICOLA
Entity type:Individual
Prefix:
First Name:NICOLA
Middle Name:
Last Name:DINE
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 1:9 FORSTER ST # 1
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-2706
Mailing Address - Country:US
Mailing Address - Phone:617-909-0213
Mailing Address - Fax:
Practice Address - Street 1:57 PUTNAM ST
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-2902
Practice Address - Country:US
Practice Address - Phone:617-909-0213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health