Provider Demographics
NPI:1194153403
Name:NISHIJIMA, MISATO
Entity type:Individual
Prefix:
First Name:MISATO
Middle Name:
Last Name:NISHIJIMA
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 1:235 COMMONWEALTH AVE
Mailing Address - Street 2:CHESTNUT HILL
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1011
Mailing Address - Country:US
Mailing Address - Phone:617-637-5256
Mailing Address - Fax:
Practice Address - Street 1:14 FORDHAM RD.
Practice Address - Street 2:ARBOUR COUNSELING SERVICES OF ALLSTON
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134
Practice Address - Country:US
Practice Address - Phone:617-782-6260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA218900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker