Healthcare Provider Details

I. General information

NPI: 1417184698
Provider Name (Legal Business Name): NICOLE C. ESPOSITO ED.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CONVERSE ST # 3L
LONGMEADOW MA
01106-1675
US

IV. Provider business mailing address

31 MAPLE TER
LONGMEADOW MA
01106-2643
US

V. Phone/Fax

Practice location:
  • Phone: 413-636-2344
  • Fax:
Mailing address:
  • Phone: 413-636-2344
  • Fax: 413-781-1059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8784
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number002443
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: