Provider Demographics
NPI:1437931151
Name:NICOLE DANIELLE THERAPY, LLC
Entity Type:Organization
Organization Name:NICOLE DANIELLE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TARRANT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-887-8609
Mailing Address - Street 1:1145 N COLONY RD STE 3 #1043
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492
Mailing Address - Country:US
Mailing Address - Phone:203-887-8609
Mailing Address - Fax:
Practice Address - Street 1:22 WHITE TAIL LN
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-5349
Practice Address - Country:US
Practice Address - Phone:203-887-8609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)