Individual
NICOLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
63 MAIN ST, BROCKTON, MA 02301
(508) 559-6699
(508) 559-5073
Mailing address
63 MAIN ST, BROCKTON, MA 02301-4042
(508) 559-6699
(508) 559-5073
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
221869
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110026265E
—
MA
Enumeration date
09/10/2015
Last updated
01/28/2019
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