| Doctor Name: | NICOLE MCMINN |
| NPI Number: | 1013361542 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MFT |
| License Number: | |
| Business Practice Address: | 20 Tuttle Pl Middletown, CT - 064571870 |
| Business Phone Number: | 8606323235 |
| Business Fax Number: | |
| Mailing Address: | 189 Mansion Rd, CHESHIRE |
| State: | CT |
| Postal Code: | 064103428 |
| Phone Number: | 2035846373 |
| Fax Number: | |
| NPI Enumeration Date: | 04/21/2016 |
| NPI Last Update Date: | 04/21/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |