Nicholas Desimone

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

37PC00776800 Issued in NJ

Practice address

1395 Chews Landing Rd
Laurel Springs, NJ 08021

Phone

(856) 258-7575

NPI assigned

Feb 7, 2017

Reactivated

Oct 3, 2018

Last updated

Jul 16, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Changing Tides Wellness Center LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Marlton, NJ
  • NPI 1174304190
  NPD Authorized official
• Kingsway Recovery LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Mullica Hill, NJ
  • NPI 1639697782

  Addiction (Substance Use Disorder)

  NPD Authorized official
• Renewed Light LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • West Deptford, NJ
  • NPI 1104578889
  NPD Authorized official
• Victory Bay Recovery Center, LLC

  • Substance Abuse Rehabilitation Facility
  • Laurel Springs, NJ
  • NPI 1700328283
  NPD (past)

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

{
    "created_epoch": "1486425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626393600000",
    "number": "1346788676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 CHEWS LANDING RD",
            "city": "LAUREL SPRINGS",
            "state": "NJ",
            "postal_code": "08021",
            "telephone_number": "856-258-7575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1395 CHEWS LANDING RD",
            "city": "LAUREL SPRINGS",
            "state": "NJ",
            "postal_code": "08021",
            "telephone_number": "856-258-7575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESIMONE",
        "first_name": "NICHOLAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-07",
        "last_updated": "2021-07-16",
        "certification_date": "2021-07-16",
        "deactivation_date": "2018-08-21",
        "reactivation_date": "2018-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NJ",
            "license": "37LC00251500",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NJ",
            "license": "37LC00251500",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NJ",
            "license": "37PC00776800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marisa Cinalli, MSN,RN,APN-C
• Jenna Connor
• Joseph J. Conti, D.O.
• Kristin Curi
• Dennis Ribatsky, D.D.S., P.a.
• Luckym Van Dinh, DDS
• Kathleen M. Dwyer
• Eastern Dental of Laurel Springs, LLC
• Donnajean Ebert, MSW, LSW
• Eckerd Corporation (Rite Aid Pharmacy 10440)

• Professional Counselor in Laurel Springs, NJ
• Providers in Laurel Springs, NJ by specialty
• Professional Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2021; 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.