Nicole Dallas

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

Q1-0012293 Issued in DE

Practice address

586 County Route 9
Ghent, NY 12075-2312

Phone

(518) 965-2648

NPI assigned

Jun 23, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DE

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Survivors of Abuse in Recovery IncGroup PAC ID 1850294067, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Survivors of Abuse in Recovery, Inc.

  dba Soar

  • Family Psychologist
  • Wilmington, DE
  • NPI 1154386696

  Clinical

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1687478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687478400000",
    "number": "1306522578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "586 COUNTY ROUTE 9",
            "city": "GHENT",
            "state": "NY",
            "postal_code": "120752312",
            "telephone_number": "518-965-2648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "586 COUNTY ROUTE 9",
            "city": "GHENT",
            "state": "NY",
            "postal_code": "120752312",
            "telephone_number": "518-965-2648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALLAS",
        "first_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-23",
        "last_updated": "2023-06-23",
        "certification_date": "2023-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "DE",
            "license": "Q1-0012293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Gail Baltay, LMSW
• Megan K Bretz
• Juanita M Bryant, R.D., CDN
• Capital Region Otolaryngology Head & Neck Group
• Chatham Pediatrics, PLLC
• Kenneth Dechman, OTD, OTR/L
• Jason B Detzel, B.C.B.A.
• Karyn Maria Dornemann, D.C.
• Bethany Dugan, OTR/L
• Loudes Gozon Dumadag, PT

• Clinical Social Worker in Ghent, NY
• Providers in Ghent, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.