Individual provider Active NPI

Nicole Simonson, LICSW

  • Clinical Social Worker
  • Boston, MA
National Provider Identifier
1164830659
Registry record updated Apr 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
117621 Issued in MA
Practice address
332 Hanover St
Boston, MA 02113-1901
Phone
(617) 643-8000
NPI assigned
Jul 28, 2014
Last updated
Apr 7, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2026

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 117621 MA Primary

Addresses

Primary practice location

332 Hanover St
Boston, MA 02113-1901

Mailing address

332 Hanover St
Boston, MA 02113-1901
Phone (617) 643-8000

Other practice location 1

300 Baker Ave Ste 300
Concord, MA 01742-2124
Phone (864) 336-2731

Other identifiers 1

IdentifierTypeStateIssuer
117621OtherMAMASSACHUSETTS LICSW LICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20240917003692 MA Practitioner - Clinical Social Worker 6709327869 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
117621MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Holding Harbor, LLC Clinical Current Accepting new patients

Organizations & group practices 2

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": "1406505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775520000000",
    "number": "1164830659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "332 HANOVER ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021131901",
            "telephone_number": "617-643-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "332 HANOVER ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021131901",
            "telephone_number": "617-643-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Baker Ave Ste 300",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "MA",
            "postal_code": "017422124",
            "country_code": "US",
            "telephone_number": "864-336-2731",
            "fax_number": "833-740-3387",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIMONSON",
        "first_name": "NICOLE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-28",
        "last_updated": "2026-04-07",
        "certification_date": "2026-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "117621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MASSACHUSETTS LICSW LICENSE NUMBER",
            "identifier": "117621",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.