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General NPI Number Information
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NPI Number | 1194154344
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Entity Type | Individual
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Provider Name | NICOLE BUNNELL LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/08/2013
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Last Update Date | 11/08/2013
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Provider Practice Location Address
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Address Line | 159 MEADOW ST
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City | NAUGATUCK
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State | CT
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Zip | 06770-4042
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Country | US
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Telephone | 203-695-1108
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Fax |
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Provider Business Mailing Address
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Address Line | 18 LAURA LN
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City | OXFORD
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State | CT
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Zip | 06478-1830
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Country | US
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Telephone | 203-695-1108
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 006424
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License Number State | CT
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