Healthcare Provider Details

I. General information

NPI: 1134650237
Provider Name (Legal Business Name): NICOLE DICKENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE BATTISTONE

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 MIGEON AVE
TORRINGTON CT
06790-4643
US

IV. Provider business mailing address

469 MIGEON AVE
TORRINGTON CT
06790-4643
US

V. Phone/Fax

Practice location:
  • Phone: 860-489-0931
  • Fax:
Mailing address:
  • Phone: 860-489-0931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4585
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: