Provider Demographics
NPI:1720286982
Name:KIRBY, NICOLE M (LCMHC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:KIRBY
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:BISAILLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMHC
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:EAST DOVER
Mailing Address - State:VT
Mailing Address - Zip Code:05341
Mailing Address - Country:US
Mailing Address - Phone:347-342-6259
Mailing Address - Fax:802-419-9706
Practice Address - Street 1:229 WESTERN AVENUE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301
Practice Address - Country:US
Practice Address - Phone:347-342-6259
Practice Address - Fax:802-419-9706
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005155-1101YM0800X
VT068.0087757101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health