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General NPI Number Information
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NPI Number | 1013537760
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Entity Type | Individual
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Provider Name | NICOLE MARIE ALEXOPOULOS MSAP
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Gender | Female
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Dates
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Enumeration Date | 04/23/2020
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Last Update Date | 04/23/2020
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Provider Practice Location Address
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Address Line | 1250 SILVER ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3946
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Country | US
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Telephone | 860-972-1106
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Fax | 860-346-6108
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Provider Business Mailing Address
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Address Line | 46 MADISON AVE
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City | WALLINGFORD
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State | CT
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Zip | 06492-5120
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Country | US
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Telephone | 203-599-5067
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Fax | 860-346-1106
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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