Provider Demographics
NPI:1053488577
Name:MERLO-WHITE, NICOLE LEANN (LMFT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEANN
Last Name:MERLO-WHITE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LEANN
Other - Last Name:MERLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:146 GILLIES LN
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-1009
Mailing Address - Country:US
Mailing Address - Phone:203-209-1883
Mailing Address - Fax:
Practice Address - Street 1:146 GILLIES LN
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-1009
Practice Address - Country:US
Practice Address - Phone:203-209-1883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001029106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT410001029CT01OtherANTHEM BLUE CROSS BLUE SH
286914OtherMHN