Provider Demographics
NPI:1003125899
Name:TESSIER, NICOLE RYANN (MSW, LICSW)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:RYANN
Last Name:TESSIER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 S MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-1872
Mailing Address - Country:US
Mailing Address - Phone:774-473-8117
Mailing Address - Fax:
Practice Address - Street 1:46 S MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05676-1872
Practice Address - Country:US
Practice Address - Phone:774-473-8117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.0099816101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health