Provider Demographics
NPI:1548434798
Name:NELSON, TERRI RENEE (LICSW)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:RENEE
Last Name:NELSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-2946
Mailing Address - Country:US
Mailing Address - Phone:617-296-7797
Mailing Address - Fax:
Practice Address - Street 1:53 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2946
Practice Address - Country:US
Practice Address - Phone:617-296-7797
Practice Address - Fax:617-296-3745
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical