Nicole Nefosky, LMFT

Key facts

NPI

1104451657

Entity type

Individual (NPI type 1)

Primary specialty

Marriage & Family Therapist 106H00000X

License

FT-0000061 (DE)

Practice address

300 Biddle Ave Ste 207
Newark, DE 19702-3972

Phone

(302) 224-1400

NPI assigned

Mar 5, 2020

Sex

Female

Sole proprietor

No

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 and National Provider Directory roles.

• Mid-Atlantic Behavioral Health, LLC Intellectual & Developmental Disabilities Psychologist · Newark, DE · NPI 1871719872
  Medicare reassignment DE

Medicare participation

Medicare fee-for-service enrollment

Enrolled in DE

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Interoperability endpoints

• Direct secure messaging: lifestancehealth.nicolenefosky@148542.advancedmd-direct.com

Specialties & licenses

Addresses

Other names

• Nicole Schellinger Former name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 5, 2020.

{
    "created_epoch": "1583366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583366400000",
    "number": "1104451657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 S CHAPEL ST STE 102",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197133468",
            "telephone_number": "302-224-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 BIDDLE AVE STE 207",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197023972",
            "telephone_number": "302-224-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEFOSKY",
        "first_name": "NICOLE",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-05",
        "last_updated": "2020-03-05",
        "certification_date": "2020-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "DE",
            "license": "FT-0000061",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "SCHELLINGER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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