Provider Demographics
NPI:1689801508
Name:BRAIN, NICHOLA ASHFORD
Entity Type:Individual
Prefix:MISS
First Name:NICHOLA
Middle Name:ASHFORD
Last Name:BRAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 HUNTINGTON RD
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-3402
Mailing Address - Country:US
Mailing Address - Phone:203-984-3743
Mailing Address - Fax:
Practice Address - Street 1:59 ROXBURY ROAD
Practice Address - Street 2:BRIGHTON GARDENS OF STAMFORD
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902
Practice Address - Country:US
Practice Address - Phone:203-329-0106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003148235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist