Provider Demographics
NPI:1134351885
Name:MARSHALL, NICOLE SIRRINE (PHD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:SIRRINE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:SIRRINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:10 FOREST PARK DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1499
Mailing Address - Country:US
Mailing Address - Phone:860-269-7813
Mailing Address - Fax:860-269-8621
Practice Address - Street 1:10 FOREST PARK DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1499
Practice Address - Country:US
Practice Address - Phone:860-269-7813
Practice Address - Fax:860-269-8621
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2958103TB0200X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent