Active NPI
Nicole Marin Kertamus
- Clinical Social Worker
- West Valley City, UT
National Provider Identifier
1376079673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 13633645-3502
- Practice address
- 3725 W 4100 S Ste 150
West Valley City, UT 84120-5419 - Phone
- (801) 578-2351
- NPI assigned
- May 4, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 13633645-3502 | UT | Primary |
Addresses
Primary practice location
3725 W 4100 S Ste 150
West Valley City, UT 84120-5419
Mailing address
76 E Inlet Spring Dr
Saratoga Springs, UT 84045-5567
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13633645-3502 | UT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1493856000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699228800000",
"number": "1376079673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "76 E INLET SPRING DR",
"city": "SARATOGA SPRINGS",
"state": "UT",
"postal_code": "840455567"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3725 W 4100 S STE 150",
"city": "WEST VALLEY CITY",
"state": "UT",
"postal_code": "841205419",
"telephone_number": "801-578-2351"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KERTAMUS",
"first_name": "NICOLE",
"middle_name": "MARIN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-05-04",
"last_updated": "2023-11-06",
"certification_date": "2023-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "UT",
"license": "13633645-3502",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Valley City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.