| Doctor Name: | NICHOLE FENTON |
| NPI Number: | 1003230624 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 21 Montauk Avene New London, CT - 063204906 |
| Business Phone Number: | 8602714715 |
| Business Fax Number: | 8602714797 |
| Mailing Address: | 21 Montauk Avene, P.o. Box 390 NEW LONDON |
| State: | CT |
| Postal Code: | 063206344 |
| Phone Number: | 8602714715 |
| Fax Number: | 8602714797 |
| NPI Enumeration Date: | 02/18/2014 |
| NPI Last Update Date: | 03/03/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |