Healthcare Provider Details

I. General information

NPI: 1285460683
Provider Name (Legal Business Name): NICHOLE PACIELLO LMHC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 RICHMOND SQ STE 105
PROVIDENCE RI
02906-5135
US

IV. Provider business mailing address

2 RICHMOND SQ STE 105
PROVIDENCE RI
02906-5135
US

V. Phone/Fax

Practice location:
  • Phone: 315-525-1409
  • Fax: 401-216-6187
Mailing address:
  • Phone: 315-525-1409
  • Fax: 401-216-6187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. NICHOLE PACIELLO
Title or Position: OWNER /FOUNDER
Credential: LMHC
Phone: 315-525-1409