Provider Demographics
NPI:1043647373
Name:BORUSIEWICZ, NICOLE (LCSW,LMSW,MSW,BSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BORUSIEWICZ
Suffix:
Gender:
Credentials:LCSW,LMSW,MSW,BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E MAIN ST
Mailing Address - Street 2:4TH FLOOR ADMINISTRATION
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-2310
Mailing Address - Country:US
Mailing Address - Phone:203-574-9000
Mailing Address - Fax:203-574-9006
Practice Address - Street 1:141 E MAIN ST
Practice Address - Street 2:3RD FLOOR-HOME BASED SERVICES
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-2310
Practice Address - Country:US
Practice Address - Phone:203-574-9000
Practice Address - Fax:203-574-9006
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000826104100000X
CT99401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060669107OtherUBH/UNITED HEALTHCARE WELLMORE GRP/FACILITY
CT060669107OtherUBH-CONNECTICARE WELLMORE GRP/FACILITY
CT060669107OtherANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CTD339123-141 E MAINOtherBEACON HEALTH STRATEGIES
CT008065074Medicaid
CT060669107OtherUBH/OXFORD FREEDOM/LIBERTY WELLMORE GRP/FACILITY
CTCAQHOther13540261
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH
CT060669107OtherOPTUM BEHAVIORAL HEALTH WELLMORE GRP/FACILITY
CT060669107OtherAETNA BEHAVIORAL HEALTH
CTNOT ELIGIBLEOtherMHN MANAGED HEALTH NETWORK
CTNOT ELIGIBLEOtherMHN TRICARENORTH
CT060669107OtherAETNA BEHAVIORAL HEALTH