Provider Demographics
NPI:1386965549
Name:NUNEZ, MIGUEL ANGEL (CADC, LADC II)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANGEL
Last Name:NUNEZ
Suffix:
Gender:M
Credentials:CADC, LADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 CRESCENT ST
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3104
Mailing Address - Country:US
Mailing Address - Phone:508-941-0005
Mailing Address - Fax:508-427-6915
Practice Address - Street 1:142 CRESCENT ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3104
Practice Address - Country:US
Practice Address - Phone:508-941-0005
Practice Address - Fax:508-427-6915
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1483 AD101YA0400X
MA11260101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)