Individual provider Active NPI

Nicole Marie Publick, LSW

  • Social Worker
  • Souderton, PA
National Provider Identifier
1033671839
Registry record updated Apr 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
SW135845 Issued in PA
Practice address
420 Cowpath Rd
Souderton, PA 18964-2036
Phone
(267) 203-1500
Fax
(215) 703-9811
NPI assigned
Apr 2, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 2, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X SW135845 PA Primary

Addresses

Primary practice location

420 Cowpath Rd
Souderton, PA 18964-2036

Mailing address

420 Cowpath Rd
Souderton, PA 18964-2036
Phone (267) 203-1500

Other identifiers 1

IdentifierTypeStateIssuer
SW135845OtherPAPA BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190905000530 PA Practitioner - Clinical Social Worker 3274862958

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

420 Cowpath Rd
Souderton, PA 18964-2036

Indian Creek Foundation
420 Cowpath Rd
Sounderton, PA 18964-2036

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SW135845PAMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Indian Creek Foundation CurrentSince Sep 11, 2019 Accepting new patients

Locations

420 Cowpath Rd
Souderton, PA 18964
Phone (267) 203-1500

Organizations & group practices 1

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554163200000",
    "number": "1033671839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 COWPATH RD",
            "city": "SOUDERTON",
            "state": "PA",
            "postal_code": "189642036",
            "telephone_number": "267-203-1500",
            "fax_number": "215-703-9811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 COWPATH RD",
            "city": "SOUDERTON",
            "state": "PA",
            "postal_code": "189642036",
            "telephone_number": "267-203-1500",
            "fax_number": "215-703-9811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUBLICK",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "LSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-02",
        "last_updated": "2019-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "PA",
            "license": "SW135845",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS",
            "identifier": "SW135845",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Souderton, PA

Sources for this page

Verify at the official NPI Registry.