Provider Demographics
NPI:1902302417
Name:PRESENT-VANBROEKHOVEN, NANCY LOUISE (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LOUISE
Last Name:PRESENT-VANBROEKHOVEN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:MS
Other - First Name:N.
Other - Middle Name:
Other - Last Name:PRESENT VANBROEKHOVEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:70 WINDING RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-1025
Mailing Address - Country:US
Mailing Address - Phone:781-239-0374
Mailing Address - Fax:
Practice Address - Street 1:70 WINDING RIVER ROAD
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-1025
Practice Address - Country:US
Practice Address - Phone:781-239-0374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1018281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical