Provider Demographics
NPI:1285114496
Name:MILTON, NORA REGINA
Entity type:Individual
Prefix:
First Name:NORA
Middle Name:REGINA
Last Name:MILTON
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 1:79 POPLAR ST #8
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02131-2506
Mailing Address - Country:US
Mailing Address - Phone:603-548-2875
Mailing Address - Fax:
Practice Address - Street 1:150 S. HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-6773
Practice Address - Country:US
Practice Address - Phone:857-364-6863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1213251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical