Active NPI
Nicole Lerae Varkonda, LISW
- Clinical Social Worker
- Plymouth, OH
National Provider Identifier
1093236010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- I.1600725
- Practice address
- 4181 Townline Road 111
Plymouth, OH 44865 - Phone
- (419) 571-2482
- NPI assigned
- Jun 29, 2017
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | I.1600725 | OH | Primary |
Addresses
Primary practice location
4181 Townline Road 111
Plymouth, OH 44865
Mailing address
4181 Townline 111
Plymouth, OH 44865-9684
Phone (419) 571-2482
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
| License | State | Type | Specialty |
|---|---|---|---|
| I.1600725 | OH | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1093236010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4181 TOWNLINE 111",
"city": "PLYMOUTH",
"state": "OH",
"postal_code": "448659684",
"telephone_number": "419-571-2482"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4181 TOWNLINE ROAD 111",
"city": "PLYMOUTH",
"state": "OH",
"postal_code": "44865",
"telephone_number": "419-571-2482"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VARKONDA",
"first_name": "NICOLE",
"middle_name": "LERAE",
"credential": "LISW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-06-29",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OH",
"license": "I.1600725",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.