Provider Demographics
NPI:1992471965
Name:NEPHEW, JOHN JOSEPH (HS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:NEPHEW
Suffix:
Gender:M
Credentials:HS
Other - Prefix:
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:NEPHEW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-3215
Mailing Address - Country:US
Mailing Address - Phone:978-392-4428
Mailing Address - Fax:
Practice Address - Street 1:6 LINCOLN KNOLL LN STE 104
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4729
Practice Address - Country:US
Practice Address - Phone:888-805-0759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician