Provider Demographics
NPI:1215504659
Name:BENNIE, NICKOLAS
Entity type:Individual
Prefix:
First Name:NICKOLAS
Middle Name:
Last Name:BENNIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 HARDING ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1008
Mailing Address - Country:US
Mailing Address - Phone:315-956-5267
Mailing Address - Fax:
Practice Address - Street 1:33 HARDING ST APT 2
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-1008
Practice Address - Country:US
Practice Address - Phone:315-956-5267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor