Provider Demographics
NPI:1336266790
Name:NICHOLLS, SARAH SHANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:SHANE
Last Name:NICHOLLS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 WHITNEY AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3724
Mailing Address - Country:US
Mailing Address - Phone:203-789-2028
Mailing Address - Fax:
Practice Address - Street 1:291 WHITNEY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3724
Practice Address - Country:US
Practice Address - Phone:203-789-2028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002446103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical