MEDICARE: NICOLE SARA BARRETT PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ15495600	NJ

General Provider Information

NPI Number	:	1215893995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE SARA BARRETT PMHNP

Provider Business Mailing Address
First Line	:	161 CENTER GROVE RD # 234
Second Line	:
City	:	RANDOLPH
State	:	NJ
Zip	:	07869-2003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	165 PASSAIC AVE STE 200
Second Line	:
City	:	FAIRFIELD
State	:	NJ
Zip	:	07004-3526
Country	:	US
Telephone Number	:	856-818-4020
Fax Number	:	732-479-6751

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2025
Last Update Date	:	02/12/2026

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