Individual provider Active NPI

Michelle M Nickerson, LICSW

  • Clinical Social Worker
  • Amesbury, MA
National Provider Identifier
1043336324
Registry record updated May 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
121121 Issued in MA
Practice address
12 Market Square
Suite 2
Amesbury, MA 01913
Phone
(857) 285-8265
NPI assigned
Mar 21, 2007
Last updated
May 30, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 1369 NH
Clinical Social Worker 1041C0700X 2096 NH
Clinical Social Worker 1041C0700X 121121 MA Primary

Addresses

Primary practice location

12 Market Square
Suite 2
Amesbury, MA 01913

Mailing address

212 Low St
Newburyport, MA 01950-3535
Phone (857) 285-8265

Other practice location 1

99 Hanover St
Manchester, NH 03101-2203
Phone (603) 518-4118

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
121121MAMDClinical Social Worker
1369NHMDPhysician Assistant
2096NHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Finding Solace Counseling LLC Clinical Current Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527638400000",
    "number": "1043336324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 LOW ST",
            "city": "NEWBURYPORT",
            "state": "MA",
            "postal_code": "019503535",
            "telephone_number": "857-285-8265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 MARKET SQUARE",
            "address_2": "SUITE 2",
            "city": "AMESBURY",
            "state": "MA",
            "postal_code": "01913",
            "telephone_number": "857-285-8265"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "99 Hanover St",
            "address_purpose": "LOCATION",
            "city": "Manchester",
            "state": "NH",
            "postal_code": "031012203",
            "country_code": "US",
            "telephone_number": "603-518-4118",
            "fax_number": "603-668-6260",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICKERSON",
        "first_name": "MICHELLE",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-21",
        "last_updated": "2018-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NH",
            "license": "1369",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NH",
            "license": "2096",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "121121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Amesbury, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.