Healthcare Provider Details

I. General information

NPI: 1851920540
Provider Name (Legal Business Name): NICOLE PATRICIA GOLDEN APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2020
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 WASHINGTON ST
NORWICH CT
06360-2740
US

IV. Provider business mailing address

6 E BISHOP ST
WATERFORD CT
06385-2514
US

V. Phone/Fax

Practice location:
  • Phone: 860-823-6389
  • Fax:
Mailing address:
  • Phone: 860-235-2584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12.017714
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number111548
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: