Provider Demographics
NPI:1669659546
Name:DAY, NICOLE M (MA)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:M
Last Name:DAY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:COTSIFAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55 LAKE AVE N
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01655-0002
Mailing Address - Country:US
Mailing Address - Phone:508-334-1000
Mailing Address - Fax:774-443-0309
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:508-334-1000
Practice Address - Fax:774-443-0309
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18684OtherBCBS
MA1306421Medicaid
MA1308785Medicaid