Provider Demographics
NPI:1467820944
Name:BARCELOS, NICOLE M (PSYD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:M
Last Name:BARCELOS
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DEERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-4252
Mailing Address - Country:US
Mailing Address - Phone:860-270-0600
Mailing Address - Fax:860-748-4432
Practice Address - Street 1:100 DEERFIELD RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-4252
Practice Address - Country:US
Practice Address - Phone:860-270-0600
Practice Address - Fax:860-748-4432
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021324103G00000X
CT3566103TC0700X, 103G00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPRC200326293OtherCAPITAL DISTRICT PHYSICIAN'S HEALTH PLAN, INC.
NY000427298001OtherBLUESHIELD OF NORTHEASTERN NY
NYV38N41OtherEMPIRE BLUECROSS
NYA300129974Medicare PIN