Colleen Nusbaum, LCSW, CDCI

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1290 Issued in AK

Practice address

245 N Binkley St Ste 200
Soldotna, AK 99669-7500

Phone

(907) 714-4521

Fax

(907) 260-4063

NPI assigned

Jun 17, 2008

Last updated

May 19, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Lupine Family Services, LLC

  • Clinical Social Worker
  • Soldotna, AK
  • NPI 1861154262
  NPD Authorized official
• Central Peninsula General Hospital, Inc

  dba Central Peninsula Gastroenterology

  • Gastroenterology Physician
  • Soldotna, AK
  • NPI 1154194819
  NPD (past)
• Central Peninsula General Hospital, Inc

  dba Serenity House Treatment Facility

  • Community/Behavioral Health Agency
  • Kenai, AK
  • NPI 1174122766
  NPD (past)
• Central Peninsula General Hospital, Inc

  dba Diamond Willow Sober Living

  • Community/Behavioral Health Agency
  • Soldotna, AK
  • NPI 1679179204
  NPD (past)

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

{
    "created_epoch": "1213660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652918400000",
    "number": "1295996858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 N BINKLEY ST STE 200",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996697500",
            "telephone_number": "907-714-4521",
            "fax_number": "907-260-4063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 N BINKLEY ST STE 200",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996697500",
            "telephone_number": "907-714-4521",
            "fax_number": "907-260-4063"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "47480 Kristina Way",
            "address_purpose": "LOCATION",
            "city": "Kenai",
            "state": "AK",
            "postal_code": "996115902",
            "country_code": "US",
            "telephone_number": "907-714-4521",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "250 Hospital Pl",
            "address_purpose": "LOCATION",
            "city": "Soldotna",
            "state": "AK",
            "postal_code": "996697559",
            "country_code": "US",
            "telephone_number": "907-714-4521",
            "fax_number": "907-260-4063",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "354 Tyee St",
            "address_purpose": "LOCATION",
            "city": "Soldotna",
            "state": "AK",
            "postal_code": "996697657",
            "country_code": "US",
            "telephone_number": "907-714-4521",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "362 Tyee St",
            "address_purpose": "LOCATION",
            "city": "Soldotna",
            "state": "AK",
            "postal_code": "996697631",
            "country_code": "US",
            "telephone_number": "907-714-4521",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NUSBAUM",
        "first_name": "COLLEEN",
        "credential": "LCSW, CDCI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-17",
        "last_updated": "2022-05-19",
        "certification_date": "2020-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "AK",
            "license": "4053",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AK",
            "license": "1290",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMG675",
            "state": "AK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cnusbaum749283@ak.providencedirect.org",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "address_1": "245 N Binkley St Ste 200",
            "city": "Soldotna",
            "state": "AK",
            "country_code": "US",
            "postal_code": "996697500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• North Star Therapy Inc.
• Northern Lighthouse Dba Northern Lighthouse Day Center
• Northern Nursing Services, Inc.
• Northern Orthopedics Inc
• Northern Psychology Resources LLC
• Hannah Camilla Nusbaum, LMT
• Daniel D Nyitrai, PA-C
• Jonathan Michael O'Brien
• Eric Clifford O'Guinn, CPO
• Vidya H. Oftedal, SLP

• Clinical Social Worker in Soldotna, AK
• Providers in Soldotna, AK by specialty
• Clinical Social Worker in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.