Provider Demographics
NPI:1720818859
Name:KIDD-TAYLOR, NICOLE (LPC-A)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:KIDD-TAYLOR
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 FOSTER STREET EXT
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-2113
Mailing Address - Country:US
Mailing Address - Phone:860-982-6927
Mailing Address - Fax:
Practice Address - Street 1:337 E RIVER DR
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-4202
Practice Address - Country:US
Practice Address - Phone:860-982-6927
Practice Address - Fax:860-291-3159
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional