Active NPI
Nichele Y Thompson, LICSW
- Clinical Social Worker
- Brockton, MA
National Provider Identifier
1245599166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LICSW120560
- Practice address
- 63 Main St
Brockton, MA 02301-4042 - Phone
- (508) 559-6699
- NPI assigned
- May 12, 2012
- Sex
- Female
- Sole proprietor
- No
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 | LICSW120560 | MA | Primary |
Addresses
Primary practice location
63 Main St
Brockton, MA 02301-4042
Mailing address
63 Main St
Brockton, MA 02301-4042
Phone (508) 559-6699
Other practice location 1
637 Washington St
Dorchester, MA 02124-3510
Phone (617) 825-9660
Other practice location 2
50 Redfield St
Suite # 300
Dorchester, MA 02122-3630
Phone (617) 288-7450
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110183526A | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LICSW120560 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1336780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710201600000",
"number": "1245599166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "63 MAIN ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023014042",
"telephone_number": "508-559-6699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "63 MAIN ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023014042",
"telephone_number": "508-559-6699"
}
],
"practiceLocations": [
{
"address_1": "637 Washington St",
"address_purpose": "LOCATION",
"city": "Dorchester",
"state": "MA",
"postal_code": "021243510",
"country_code": "US",
"telephone_number": "617-825-9660",
"fax_number": "617-288-7898",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "50 Redfield St",
"address_2": "Suite # 300",
"address_purpose": "LOCATION",
"city": "Dorchester",
"state": "MA",
"postal_code": "021223630",
"country_code": "US",
"telephone_number": "617-288-7450",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "THOMPSON",
"first_name": "NICHELE",
"middle_name": "Y",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-05-12",
"last_updated": "2024-03-12",
"certification_date": "2024-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "LICSW120560",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110183526A",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.