Neurodiverse Therapy, LLC

Primary specialty

Social WorkerTaxonomy code 104100000X

Legal business name

NEURODIVERSE THERAPY, LLC

Practice address

209 Willow Ave
Fort Knox, KY 40121-4513

Phone

(561) 414-6016

NPI assigned

May 4, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stacey ZimmermanNPI 1225595515

Title

LCSW/ Owner

Phone

(561) 414-6016

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, KY2 enrollments

Enrollment records 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stacey Zimmerman, LCSW

  • Clinical Social Worker
  • Eglin Afb, FL
  • NPI 1225595515

  KY

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683158400000",
    "number": "1255020368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 WILLOW AVE",
            "city": "FORT KNOX",
            "state": "KY",
            "postal_code": "401214513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 WILLOW AVE",
            "city": "FORT KNOX",
            "state": "KY",
            "postal_code": "401214513",
            "telephone_number": "561-414-6016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEURODIVERSE THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-04",
        "last_updated": "2023-05-04",
        "certification_date": "2023-05-04",
        "status": "A",
        "authorized_official_last_name": "ZIMMERMAN",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "LCSW/ OWNER",
        "authorized_official_telephone_number": "561-414-6016"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Robert Nadeau, D.O., MHSA
• Shivaun Nafsu
• National Vision, Inc.
• Timothy Joseph Nawrocki, D.D.S
• Kyle Richard Nebelsick, PHARM.D.
• Mary Alice Noel, MD
• Maureen Joan O'Brien, OTR/L
• Jose Mari Ortiz, M.D.
• Robert Anthony Padgett, MD
• Daniel S Park, PA-C

• Social Worker in Fort Knox, KY
• Providers in Fort Knox, KY by specialty
• Social Worker in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.