Active NPI
Nicole L Jackman, LCSW-C
- Clinical Social Worker
- Westminster, MD
National Provider Identifier
1063629624
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 12780
- Practice address
- 7 School House Ave Ste 101
Westminster, MD 21157-4566 - Phone
- (410) 876-1233
- NPI assigned
- May 16, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 12780 | MD | Primary |
Addresses
Primary practice location
7 School House Ave Ste 101
Westminster, MD 21157-4566
Mailing address
1644 Saint Paul St
Hampstead, MD 21074-2117
Phone (410) 257-0430
Other practice location 1
22 N Court St
Westminster, MD 21157-5110
Phone (410) 366-1980 ext. 277
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 615501400 | Medicaid | MD |
Other names 1
- Nicole L Kyker
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663632000000",
"number": "1063629624",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1644 SAINT PAUL ST",
"city": "HAMPSTEAD",
"state": "MD",
"postal_code": "210742117",
"telephone_number": "410-257-0430"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7 SCHOOL HOUSE AVE STE 101",
"city": "WESTMINSTER",
"state": "MD",
"postal_code": "211574566",
"telephone_number": "410-876-1233"
}
],
"practiceLocations": [
{
"address_1": "22 N Court St",
"address_purpose": "LOCATION",
"city": "Westminster",
"state": "MD",
"postal_code": "211575110",
"country_code": "US",
"telephone_number": "410-366-1980 x277",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKMAN",
"first_name": "NICOLE",
"middle_name": "L",
"credential": "LCSW-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-16",
"last_updated": "2022-09-20",
"certification_date": "2022-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "12780",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "615501400",
"state": "MD"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "NICOLE",
"last_name": "KYKER",
"middle_name": "L",
"credential": "LCSW-C",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Westminster, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.