Provider Demographics
NPI:1679870596
Name:REISER, NICOLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:REISER
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:NYGARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1121 WINDSOR AVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-3413
Mailing Address - Country:US
Mailing Address - Phone:631-680-0681
Mailing Address - Fax:
Practice Address - Street 1:1686 FARMINGTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:CT
Practice Address - Zip Code:06085-1279
Practice Address - Country:US
Practice Address - Phone:631-680-0681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1381104100000X
CT91511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker