Provider Demographics
NPI:1013361542
Name:MCMINN, NICOLE (MFT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MCMINN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:SICIGNANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:189 MANSION RD
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3428
Mailing Address - Country:US
Mailing Address - Phone:203-584-6373
Mailing Address - Fax:
Practice Address - Street 1:20 TUTTLE PL
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-1870
Practice Address - Country:US
Practice Address - Phone:860-632-3235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst