Provider Demographics
NPI:1417184698
Name:ESPOSITO, NICOLE C (EDD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:C
Last Name:ESPOSITO
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MAPLE TER
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-2643
Mailing Address - Country:US
Mailing Address - Phone:413-636-2344
Mailing Address - Fax:413-781-1059
Practice Address - Street 1:1200 CONVERSE ST
Practice Address - Street 2:# 3L
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1675
Practice Address - Country:US
Practice Address - Phone:413-636-2344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8784101YM0800X
CT002443101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health