Nikolas M Bertucci
Individual provider Active NPI Social Worker · Channahon, IL
NPI 1285345462 · NPPES record last updated Dec 8, 2022
Key facts
- NPI
- 1285345462
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- Practice address
- 24735 W Eames St Unit 11
Channahon, IL 60410-8712 - Phone
- (815) 290-5260
- NPI assigned
- Dec 8, 2022
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | IL | Yes |
Addresses
Primary practice location
24735 W Eames St Unit 11
Channahon, IL 60410-8712
Mailing address
24735 W Eames St Unit 11
Channahon, IL 60410-8712
Phone (815) 290-5260
Other providers in Channahon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 8, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.