Basic Information
| Provider Information | |||||||||
| NPI: | 1972716454 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRUJILLO | ||||||||
| FirstName: | NILSA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.ED | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 221 | ||||||||
| Address2: | RIDGEWOOD DRIVE | ||||||||
| City: | RUSSELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010710221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4139771773 | ||||||||
| FaxNumber: | 4137341561 | ||||||||
| Practice Location | |||||||||
| Address1: | 2155 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011043301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137360395 | ||||||||
| FaxNumber: | 4137341651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.