Healthcare Provider Details

I. General information

NPI: 1962903567
Provider Name (Legal Business Name): NICKISHA NEWELL BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 MAIN ST
EAST HARTFORD CT
06118-1885
US

IV. Provider business mailing address

287 MAIN ST
EAST HARTFORD CT
06118-1885
US

V. Phone/Fax

Practice location:
  • Phone: 860-569-5900
  • Fax:
Mailing address:
  • Phone: 860-569-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: