Healthcare Provider Details

I. General information

NPI: 1770405110
Provider Name (Legal Business Name): MS. NICOLE MERCADANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

2 CORPORATE DR STE 950
SHELTON CT
06484-6246
US

IV. Provider business mailing address

38 LYNNCREST DR
STRATFORD CT
06614-4749
US

V. Phone/Fax

Practice location:
  • Phone: 203-293-8415
  • Fax:
Mailing address:
  • Phone: 646-761-5667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17116
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: