Healthcare Provider Details

I. General information

NPI: 1417547720
Provider Name (Legal Business Name): NICOLE JEAN GIGLIOTTI MS, LCDP, QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 TEN ROD RD STE F207C
NORTH KINGSTOWN RI
02852-4172
US

IV. Provider business mailing address

16 HOMELAND ST
JOHNSTON RI
02919-5111
US

V. Phone/Fax

Practice location:
  • Phone: 401-405-1839
  • Fax:
Mailing address:
  • Phone: 401-256-8467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP00835
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: