Healthcare Provider Details

I. General information

NPI: 1972381150
Provider Name (Legal Business Name): NIKIME HEADLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45-75 PRINDLE HILL ROAD
ORANGE CT
06477
US

IV. Provider business mailing address

45-75 PRINDLE HILL ROAD
ORANGE CT
06477
US

V. Phone/Fax

Practice location:
  • Phone: 203-507-5917
  • Fax:
Mailing address:
  • Phone: 203-507-5917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7347
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: