Individual provider Active NPI

Michelle Holler

  • Clinical Social Worker
  • West Creek, NJ
National Provider Identifier
1083802755
Registry record updated Feb 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
44SC05313100 Issued in NJ
Practice address
1064 S Main St
BLDG 1E Room 203
West Creek, NJ 08092-2912
Phone
(732) 610-7534
NPI assigned
Oct 9, 2007
Last updated
Feb 7, 2017By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 7, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 44SC05313100 NJ Primary

Addresses

Primary practice location

1064 S Main St
BLDG 1E Room 203
West Creek, NJ 08092-2912

Mailing address

1970 Breakers Dr
Barnegat, NJ 08005-2646
Phone (732) 610-7534

Other identifiers 1

IdentifierTypeStateIssuer
0169412MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20071226000228 NJ Practitioner - Clinical Social Worker 1254421589 Reassigns benefits to 1 organization
Practice locations: West Creek, NJ

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Supportive Care Psychology of NJ PCGroup PAC ID 6002162252, 23 clinicians

Practice addresses (Care Compare)

1064 S Main St
West Creek, NJ 08092-2912
Phone (732) 610-7534

2350 Hospital Rd
Allenwood, NJ 08720-7037
Phone (718) 298-4375

Merit-based Incentive Payment System (MIPS)

Final score
96.24 of 100Reported as group
Quality
81.01
Improvement activities
40
Cost
88.95

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
44SC05313100NJMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Supportive Care Psychology of NJ PC CurrentSince Jan 15, 2024 Accepting new patients

Locations

27 Randolph Rd
Howell, NJ 07731
Phone (972) 677-7951

560 Berkeley Ave
Orange, NJ 07050
Phone (973) 672-6500

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": "1191888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486425600000",
    "number": "1083802755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1970 BREAKERS DR",
            "city": "BARNEGAT",
            "state": "NJ",
            "postal_code": "080052646",
            "telephone_number": "732-610-7534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1064 S MAIN ST",
            "address_2": "BLDG 1E ROOM 203",
            "city": "WEST CREEK",
            "state": "NJ",
            "postal_code": "080922912",
            "telephone_number": "732-610-7534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLER",
        "first_name": "MICHELLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-09",
        "last_updated": "2017-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05313100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0169412",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Creek, NJ

Sources for this page

Verify at the official NPI Registry.