Provider Demographics
NPI:1255635512
Name:CARDARELLI, NICOLE NEWELL (MED, LMHC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:NEWELL
Last Name:CARDARELLI
Suffix:
Gender:F
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 ELLISON PARK
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-6116
Mailing Address - Country:US
Mailing Address - Phone:617-458-3121
Mailing Address - Fax:
Practice Address - Street 1:44 ELLISON PARK
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-6116
Practice Address - Country:US
Practice Address - Phone:617-458-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9092101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health