Provider Demographics
NPI:1053987503
Name:PERTELESI, NICOLE (ATR-BC, LCAT)
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:
Last Name:PERTELESI
Suffix:
Gender:F
Credentials:ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06855-1404
Mailing Address - Country:US
Mailing Address - Phone:303-803-8238
Mailing Address - Fax:
Practice Address - Street 1:43 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06855-1404
Practice Address - Country:US
Practice Address - Phone:303-803-8238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001597221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist