Individual
DR. NICOLE DANFORTH
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
55 FRUIT STREET, YAW 6900 CHILD & ADOLESCENT PSYCHIATRY, BOSTON, MA 02114
(617) 724-6300
(617) 726-5567
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
202911
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2082161
—
MA
01
—
J28114
BCBS MA
MA
Enumeration date
04/14/2006
Last updated
07/08/2007
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