Nicole Marie Gagne

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

101YP2500X Issued in MA

Practice address

52 Lake Dr
Leicester, MA 01524-2007

Phone

(978) 390-3489

NPI assigned

Aug 31, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Nicole Marie Gonyea Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1693440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693440000000",
    "number": "1235914722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52 LAKE DR",
            "city": "LEICESTER",
            "state": "MA",
            "postal_code": "015242007",
            "telephone_number": "978-390-3489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52 LAKE DR",
            "city": "LEICESTER",
            "state": "MA",
            "postal_code": "015242007",
            "telephone_number": "978-390-3489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAGNE",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-08-31",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "MA",
            "license": "101YP2500X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "GONYEA",
            "middle_name": "MARIE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• All providers in Leicester, MA
• Professional Counselor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.