Nicole Gagnon

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

12336

Practice address

134 Church St
Willimantic, CT 06226-2612

Phone

(860) 450-7130

Fax

(860) 963-4979

NPI assigned

Sep 24, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• State of Connecticut

  • Adult Mental Health Clinic/Center
  • Norwich, CT
  • NPI 1902831548
  Medicare reassignment
• Community Health Resources, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Windsor, CT
  • NPI 1215979810
  NPD (past)

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

{
    "created_epoch": "1443052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659571200000",
    "number": "1578932158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 FERNWOOD ST",
            "city": "PLAINFIELD",
            "state": "CT",
            "postal_code": "063742109",
            "telephone_number": "860-917-0819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 CHURCH ST",
            "city": "WILLIMANTIC",
            "state": "CT",
            "postal_code": "062262612",
            "telephone_number": "860-450-7130",
            "fax_number": "860-963-4979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAGNON",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-24",
        "last_updated": "2022-08-04",
        "certification_date": "2022-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": "12336",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Mae Frankland, RD, CDN
• Talia C Freda
• Alicia Batchel Frederick
• Robert M Friedman, MD
• Ana Fuentes
• Elizabeth A Gallant
• Lorraine Brown Gallup, L.P.C.
• Gary L. Berman, D.M.D.,PC
• Merry Ellen Gasorek
• Linda Gechas, APRN

• Clinical Social Worker in Willimantic, CT
• Providers in Willimantic, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.