Provider Demographics
NPI:1679993323
Name:NICKOU, CONNIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:
Last Name:NICKOU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N MADISON RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-5028
Mailing Address - Country:US
Mailing Address - Phone:203-779-5490
Mailing Address - Fax:203-896-9830
Practice Address - Street 1:311 N MADISON RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-5028
Practice Address - Country:US
Practice Address - Phone:203-779-5490
Practice Address - Fax:203-896-9830
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002270103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical