Provider Demographics
NPI:1154577351
Name:NELSON, PAUL (MED)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 HEARTHSTONE
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:NH
Mailing Address - Zip Code:03086-5011
Mailing Address - Country:US
Mailing Address - Phone:603-801-4076
Mailing Address - Fax:
Practice Address - Street 1:77 E MERRIMACK ST STE 1
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1900
Practice Address - Country:US
Practice Address - Phone:978-453-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health