Active NPI
Marlene Popeo Nickerson
- Marriage & Family Therapist
- East Lyme, CT
National Provider Identifier
1780902189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 000658
- Practice address
- 15 Jean Dr
East Lyme, CT 06333-1541 - Phone
- (860) 739-5870
- NPI assigned
- May 10, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 000658 | CT | Primary |
Addresses
Primary practice location
15 Jean Dr
East Lyme, CT 06333-1541
Mailing address
15 Jean Dr
East Lyme, CT 06333-1541
Phone (860) 739-5870
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000658 | CT | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1273449600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1273449600000",
"number": "1780902189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 JEAN DR",
"city": "EAST LYME",
"state": "CT",
"postal_code": "063331541",
"telephone_number": "860-739-5870"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 JEAN DR",
"city": "EAST LYME",
"state": "CT",
"postal_code": "063331541",
"telephone_number": "860-739-5870"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKERSON",
"first_name": "MARLENE",
"middle_name": "POPEO",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-05-10",
"last_updated": "2010-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CT",
"license": "000658",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Lyme, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.