Active NPI
Nicole M Thomas, LCSW
- Social Worker
- Marlton, NJ
National Provider Identifier
1063151090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- Q10012082
- Practice address
- 975 Route 73 N Ste a
Marlton, NJ 08053-1281 - Phone
- (718) 644-0854
- NPI assigned
- May 28, 2022
- Last updated
- Mar 7, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 44SC06125900 | NJ | |
| Social Worker | 104100000X | Q30000079 | DE | |
| Social Worker | 104100000X | Q10012082 | DE | Primary |
Addresses
Primary practice location
975 Route 73 N Ste a
Marlton, NJ 08053-1281
Mailing address
65 Mainbridge LN
Willingboro, NJ 08046-2101
Phone (718) 644-0854
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| Q10012082 | DE | MD | Social Worker |
| Q30000079 | DE | MD | Social Worker |
| 44SC06125900 | NJ | MD | Social Worker |
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.
-
- Clinical Social Worker
- Marlton, NJ
- NPI 1922716620
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1653696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709769600000",
"number": "1063151090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "65 MAINBRIDGE LN",
"city": "WILLINGBORO",
"state": "NJ",
"postal_code": "080462101",
"telephone_number": "718-644-0854"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "975 ROUTE 73 N STE A",
"city": "MARLTON",
"state": "NJ",
"postal_code": "080531281",
"telephone_number": "718-644-0854"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMAS",
"first_name": "NICOLE",
"middle_name": "M",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-05-28",
"last_updated": "2024-03-07",
"certification_date": "2024-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NJ",
"license": "44SC06125900",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "DE",
"license": "Q30000079",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "DE",
"license": "Q10012082",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Marlton, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.