Provider Demographics
NPI:1093071136
Name:GAUGHAN, NICHOLAS (LPC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:GAUGHAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:CT
Mailing Address - Zip Code:06263-0296
Mailing Address - Country:US
Mailing Address - Phone:860-634-0967
Mailing Address - Fax:
Practice Address - Street 1:70 MAIN ST
Practice Address - Street 2:
Practice Address - City:GRISWOLD
Practice Address - State:CT
Practice Address - Zip Code:06351-2226
Practice Address - Country:US
Practice Address - Phone:860-634-0967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001066101YA0400X
CT2682101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1066OtherLADC
CT2682OtherLPC