Provider Demographics
NPI:1972264158
Name:MCENERNEY, NICOLE KATHERINE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:KATHERINE
Last Name:MCENERNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 JEM WOODS RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1594
Mailing Address - Country:US
Mailing Address - Phone:120-385-6393
Mailing Address - Fax:203-307-1771
Practice Address - Street 1:105 TRUMBULL ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-3809
Practice Address - Country:US
Practice Address - Phone:203-524-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0101351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical