Nicole Lippert
Individual provider Active NPI Clinical Social Worker · Whitehall, MI
NPI 1104475680 · NPPES record last updated Sep 8, 2019
Key facts
- NPI
- 1104475680
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 6801100189 (MI)
- Practice address
- 1321 E Colby St Ste 2
Whitehall, MI 49461-1209 - Phone
- (616) 204-2366
- NPI assigned
- Sep 8, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241123000133 | MI | Practitioner - Clinical Social Worker | 2961937289 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801100189 | MI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Out Side in, Inc. | Clinical | Current |
Accepting new patients |
| Harbor Psychological Associates PC | Current |
Accepting new patients |
Locations
12511 152nd Ave
Grand Haven, MI 49417
Phone (616) 402-4050
1148 4th St
Muskegon, MI 49441
Phone (231) 726-2299
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6801100189 | MI | Yes |
Addresses
Primary practice location
1321 E Colby St Ste 2
Whitehall, MI 49461-1209
Mailing address
8716 Meade St
Montague, MI 49437-1332
Phone (616) 204-2366
Other providers in Whitehall, MI
- Lakeshore Community Hospital, Inc.
- Lakeshore Family Dental Care
- Lakeshore Medical Center
- Meghan Lassow
- Ronald A Lehman
- Emily Macarthur
- Julie Macarthur
- Mercy Health Partners
- Mercy Health Partners
- Mercy Health Partners
All providers in Whitehall, MI · Clinical Social Worker in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.