Provider Demographics
NPI:1306527593
Name:LANSON, NICO (CPM)
Entity type:Individual
Prefix:
First Name:NICO
Middle Name:
Last Name:LANSON
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SHEPHERD ST # 1A
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-2871
Mailing Address - Country:US
Mailing Address - Phone:978-982-9991
Mailing Address - Fax:
Practice Address - Street 1:17 SHEPHERD ST # 1A
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-2871
Practice Address - Country:US
Practice Address - Phone:978-982-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPM23030191176B00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No176B00000XOther Service ProvidersMidwife