Basic Information
| Provider Information | |||||||||
| NPI: | 1467820944 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARCELOS | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 DEERFIELD RD | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060954252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602700600 | ||||||||
| FaxNumber: | 8607484432 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 DEERFIELD RD | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060954252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602700600 | ||||||||
| FaxNumber: | 8607484432 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2015 | ||||||||
| LastUpdateDate: | 07/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 3566 | CT | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | 021324 | NY | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103G00000X | 021324 | NY | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103G00000X | 3566 | CT | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
ID Information
| ID | Type | State | Issuer | Description | V38N41 | 01 | NY | EMPIRE BLUECROSS | OTHER | 000427298001 | 01 | NY | BLUESHIELD OF NORTHEASTERN NY | OTHER | PRC200326293 | 01 | NY | CAPITAL DISTRICT PHYSICIAN'S HEALTH PLAN, INC. | OTHER |