Provider Demographics
NPI:1417547720
Name:GIGLIOTTI, NICOLE JEAN (MS, LCDP, QMHP)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:JEAN
Last Name:GIGLIOTTI
Suffix:
Gender:F
Credentials:MS, LCDP, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HOMELAND ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-5111
Mailing Address - Country:US
Mailing Address - Phone:401-256-8467
Mailing Address - Fax:
Practice Address - Street 1:1130 TEN ROD RD STE F207C
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4172
Practice Address - Country:US
Practice Address - Phone:401-405-1839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-20
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP2500X
RICDP00835101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional