Nicole Marie Gaunt, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34008302A Issued in IN

Practice address

2200 Randallia Dr
Fort Wayne, IN 46805-4638

Phone

(260) 373-8000

Fax

(260) 373-8034

NPI assigned

Nov 14, 2019

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

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

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.

• Center for Neurobehavioral Services Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fort Wayne, IN
  • NPI 1548275258
  Medicare reassignment NPD

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

{
    "created_epoch": "1573689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579132800000",
    "number": "1326683228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3702 NEW VISION DR BLDG B",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 RANDALLIA DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468054638",
            "telephone_number": "260-373-8000",
            "fax_number": "260-373-8034"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3010 E State Blvd",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468054700",
            "country_code": "US",
            "telephone_number": "260-471-2300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GAUNT",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-14",
        "last_updated": "2020-01-16",
        "certification_date": "2020-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34008302A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCSW LICENSE",
            "identifier": "34008302A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34008302A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maya Gates, RBT
• Keasia Jean-Lovette Gatewood
• Gloria Gaubatz
• Shiva Gauchan, M.D.
• Jamie Gaul, PHARMD
• R Adrien Gauthier, MD
• Cassidy Gavin, RBT
• Melodie A Gavin, RN
• Mark Steven Gawel
• Mina Gayed, DO

• Clinical Social Worker in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2020; 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.

Verify at the official NPI Registry.