1306503008 NPI number — MRS. NIELLE DELAYAH MILINAZZO LMHC, ATR

Table of content: MRS. NIELLE DELAYAH MILINAZZO LMHC, ATR (NPI 1306503008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306503008 NPI number — MRS. NIELLE DELAYAH MILINAZZO LMHC, ATR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILINAZZO
Provider First Name:
NIELLE
Provider Middle Name:
DELAYAH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMHC, ATR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALFRED
Provider Other First Name:
NIELLE
Provider Other Middle Name:
DELAYAH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMHC, ATR
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306503008
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 LEXINGTON ST # 1064
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALTHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02452-4848
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-918-7245
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
738 MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 124
Provider Business Practice Location Address City Name:
WALTHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-918-7245
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  12718-MH-CC , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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