Provider Demographics
NPI:1831958750
Name:MANCINO, NICOLE MARIE (LCMC, LCMHC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:MANCINO
Suffix:
Gender:F
Credentials:LCMC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 QUAIL RUN
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-5871
Mailing Address - Country:US
Mailing Address - Phone:908-917-6990
Mailing Address - Fax:
Practice Address - Street 1:21 QUAIL RUN
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257-5871
Practice Address - Country:US
Practice Address - Phone:908-917-6990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2776101YM0800X
VT068.0135622101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health