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NICOLE ANN CONNOLLY LCSW
NPI 1700424215
Social Worker - Clinical in Derby, CT

Active since December 16, 2019PECOS Enrolled
130 DIVISION ST, DERBY, CT 06418(203) 732-7541 Get Directions Write a Review

NPPES record last updated: March 17, 2022. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jan 4, 2022, Dec 16, 2019 (2 updates tracked since 2019).

About Nicole Ann Connolly Lcsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICOLE ANN CONNOLLY LCSW (NPI 1700424215) is an individual clinical provider in Derby, Connecticut, licensed in Connecticut (11950) and active in the NPI registry since December 2019. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1700424215
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameNICOLE ANN CONNOLLYCredential: LCSW
Location Address130 DIVISION STDerby, CT 06418-1326
Mailing Address130 Division StDerby, CT 06418-1326 · (203) 732-7541
Phone(203) 732-7541
Sole ProprietorNo
Enumeration DateDecember 16, 2019
Last NPPES UpdateMarch 17, 20222 updates tracked since enumeration
NPPES CertifiedMarch 17, 2022
✔ NPI 1700424215 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in CT · 11950
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
Also ListedSocial WorkerTaxonomy 104100000X · License 4884 (CT)
130 DIVISION ST, Derby, CT 06418
Open in Google Maps ↗

Other Names 1

Former Name (1)Nicole Ann Breault Lcsw

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Nicole Ann Connolly Lcsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Nicole Connolly reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

The Griffin Hospital
Same address
General Acute Care Hospital
130 DIVISION ST
Derby, CT 06418
  • Reassigned Medicare billing, Connecticut enrollment
  • 77 clinicians in this Medicare group
NPI 1184639973 (203) 732-7360

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 06418 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$0.00 typical visit price
range $60.82 – $183.10
Typical copayment $0.00 (range $15.20 – $45.77)
Most-billed visit code NA
Established Patient
$75.55 typical visit price
range $19.76 – $149.26
Typical copayment $18.88 (range $4.94 – $37.31)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. CHRISTINA ERNST MS,RD,CDN
Dietitian, Registered
130 DIVISION ST
DERBY, CT 06418
Naugatuck Valley Planning Region (203) 732-7579
STACEY LEARY RD, CDN, CNSC
Dietitian, Registered
130 DIVISION ST
DERBY, CT 06418
Naugatuck Valley Planning Region (203) 732-7585
DR. DWAYNE ALANSIER HALL DNP
Nurse Practitioner
130 DIVISION ST
DERBY, CT 06418
Naugatuck Valley Planning Region (203) 735-7421
DR. SYBIL CHENG D.O.
Emergency Medicine (Emergency Medical Services)
130 DIVISION ST
DERBY, CT 06418
Naugatuck Valley Planning Region (203) 732-7403
PETER J. INTEGLIA CRNA
Nurse Anesthetist, Certified Registered
130 DIVISION ST
DERBY, CT 06418
Naugatuck Valley Planning Region (203) 735-6493
RORY V CONDON MSN, MA
Nurse Practitioner (Psychiatric/Mental Health)
130 DIVISION ST
DERBY, CT 06418
Naugatuck Valley Planning Region (203) 887-0604
TRENT GARCIA MD
Student in an Organized Health Care Education/Training Program
130 DIVISION ST
DERBY, CT 06418
Naugatuck Valley Planning Region (203) 735-7421
DOMENIC MICHAEL BIELLO JR. PHARMD
Pharmacist
130 DIVISION ST
DERBY, CT 06418
Naugatuck Valley Planning Region (203) 732-7450

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nicole Connolly's NPI number?

The NPI number for Nicole Connolly is 1700424215. It was assigned to this individual provider in the NPPES registry on December 16, 2019. The provider is also known as Nicole Ann Breault Lcsw.

Where is Nicole Connolly located?

Nicole Connolly practices at 130 Division St, Derby, CT 06418. The listed phone number is (203) 732-7541.

What is Nicole Connolly's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Nicole Connolly enrolled in Medicare?

Yes. Nicole Connolly is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Nicole Connolly's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Nicole Connolly reassigns Medicare benefits to The Griffin Hospital (Derby, CT). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Nicole Connolly's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Nicole Connolly was last updated on March 17, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.