Provider Demographics
NPI:1790800183
Name:WRIGHT, NICOLE (LICSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 BRUNSWICK DR
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-5148
Mailing Address - Country:US
Mailing Address - Phone:508-245-2647
Mailing Address - Fax:
Practice Address - Street 1:218 PARK ST
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-1250
Practice Address - Country:US
Practice Address - Phone:508-809-9556
Practice Address - Fax:401-244-5311
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2131151041C0700X
MA1140231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1309161Medicaid