NPIMap

Individual provider Active NPI

Elena Sergeyevna Nichols, LICSW

  • Clinical Social Worker
  • Winooski, VT
National Provider Identifier
1013588490
Registry record updated Jul 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
089.0119566 Issued in VT
Practice address
486 Main St Apt a
Winooski, VT 05404-1338
Phone
(802) 865-3450
NPI assigned
Jul 7, 2021
Sex
Female
Sole proprietor
No

Organizations & group practices 14

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Vermont Medical Center Inc 1,208 clinicians

Practice addresses (Care Compare)

111 Colchester Ave
Burlington, VT 05401-1473
Phone (802) 847-0000

Hospital & facility affiliations

  • Univ. of Vermont - Fletcher Allen Health Care Hospital, Burlington, VT, CCN 470003

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
I20210818000196 VT Practitioner - Clinical Social Worker 7416352273 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Matrix Health Systems P.C. CurrentSince Jul 22, 2021 Accepting new patients
University of Vermont Medical Center Inc CurrentSince Feb 1, 2022 Accepting new patients

Locations

111 Colchester Ave
Burlington, VT 05401
Phone (802) 656-2415

1 S Prospect St
Burlington, VT 05401
Phone (802) 847-4531

86 Lake St
Burlington, VT 05401
Phone (802) 862-8595

112 Lake St
Burlington, VT 05401
Phone (802) 999-4739

486 Main St
#A
Winooski, VT 05404
Phone (802) 432-8184

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 089.0119566 VT Primary

Addresses

NPPES NPI Registry

Primary practice location

486 Main St Apt a
Winooski, VT 05404-1338

Mailing address

486 Main St Apt a
Winooski, VT 05404-1338
Phone (802) 865-3450

Electronic endpoints 1

NPPES NPI Registry
TypeEndpointUseAffiliation
Other URL https://www.vtresiliency.com/ Direct

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 7, 2021.

{
    "created_epoch": "1625616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625616000000",
    "number": "1013588490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "486 MAIN ST APT A",
            "city": "WINOOSKI",
            "state": "VT",
            "postal_code": "054041338",
            "telephone_number": "802-865-3450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "486 MAIN ST APT A",
            "city": "WINOOSKI",
            "state": "VT",
            "postal_code": "054041338",
            "telephone_number": "802-865-3450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "ELENA",
        "middle_name": "SERGEYEVNA",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-07",
        "last_updated": "2021-07-07",
        "certification_date": "2021-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VT",
            "license": "089.0119566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.vtresiliency.com/",
            "affiliation": "N",
            "endpointDescription": "Website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "486 Main St Apt A",
            "city": "Winooski",
            "state": "VT",
            "country_code": "US",
            "postal_code": "054041338",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Winooski, VT

Sources for this page

Verify at the official NPI Registry.