Provider Demographics
NPI:1538543426
Name:TUZINSKI, NICOLE (CCPC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:TUZINSKI
Suffix:
Gender:F
Credentials:CCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2009
Mailing Address - Country:US
Mailing Address - Phone:207-854-1030
Mailing Address - Fax:207-899-4623
Practice Address - Street 1:74 STATE RD
Practice Address - Street 2:
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904-1564
Practice Address - Country:US
Practice Address - Phone:207-854-1030
Practice Address - Fax:207-899-4623
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4474101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health