Mary Nicole Cook, LISW-CP
Individual provider Active NPI Clinical Social Worker · Charleston, SC
NPI 1235830779 · NPPES record last updated Mar 13, 2023
Key facts
- NPI
- 1235830779
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 15654 (SC)
- Practice address
- 907 White Marlin Dr
Charleston, SC 29412-8400 - Phone
- (843) 860-0965
- NPI assigned
- Mar 13, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- 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 |
|---|---|---|---|---|
| I20240313001035 | SC | Practitioner - Clinical Social Worker | 1052757051 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15654 | SC | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 15654 | SC | Yes |
Addresses
Primary practice location
907 White Marlin Dr
Charleston, SC 29412-8400
Mailing address
907 White Marlin Dr
Charleston, SC 29412-8400
Phone (843) 860-0965
Other providers in Charleston, SC
- Daniel Harrison Cook
- David Thomas Cook
- Elizabeth Anne Cook
- Jenniffer Cook
- Jessica Marie Cook
- Sheena Maria Cook
- Suzanne Gill Cook
- William David Cook
- William Joel Cook
- Allison Cooke
All providers in Charleston, SC · Clinical Social Worker in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2023. 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.