Provider Demographics
NPI:1124096920
Name:NELSON, AARON PHILIP (PHD)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:PHILIP
Last Name:NELSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:221 LONGWOOD AVE
Mailing Address - Street 2:BRIGHAM BEHAVIORAL NEUROLOGY GROUP
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5804
Mailing Address - Country:US
Mailing Address - Phone:617-732-8060
Mailing Address - Fax:617-738-9122
Practice Address - Street 1:221 LONGWOOD AVE
Practice Address - Street 2:BRIGHAM BEHAVIORAL NEUROLOGY GROUP
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5804
Practice Address - Country:US
Practice Address - Phone:617-732-8060
Practice Address - Fax:617-738-9122
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA3482103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0514748Medicaid
MA703415OtherTUFTS ASSOCIATED HEALTH P
MAW03606OtherBLUE CROSS BLUE SHIELD MA
MA001336OtherVALUE OPTIONS HEALTH CARE
MA32259OtherHARVARD PILGRIM HEALTH CA
MAW03606OtherBLUE CROSS BLUE SHIELD MA
MAW03606Medicare ID - Type Unspecified