Most Relevant Information
Provider Data
| NPI Number: | 1003230624 |
| Provider Name: | NICHOLE BURNS |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/18/2014 |
| Last Updated: | 11/08/2021 |
Provider Practice Location
21 MONTAUK AVENE
NEW LONDON
CT
063204906
Practice Location Phone/Fax
| Phone: | 8602714715 |
| Fax: | 8602714797 |
Provider Mailing Location
21 MONTAUK AVENE
P.O. BOX 390
NEW LONDON
CT
063206344
Provider Mailing Phone/Fax
| Phone: | 8602714715 |
| Fax: | 8602714797 |