Healthcare Provider Details

I. General information

NPI: 1740191139
Provider Name (Legal Business Name): NICOLE HENNESSY LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 ELLEN LN
THOMASTON CT
06787-1292
US

IV. Provider business mailing address

4 ELLEN LN
THOMASTON CT
06787-1292
US

V. Phone/Fax

Practice location:
  • Phone: 203-892-5946
  • Fax:
Mailing address:
  • Phone: 203-892-5946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NICOLE MARIE HENNESSY
Title or Position: OWNER
Credential: LCSW
Phone: 203-892-5946