Nicole Dister, LSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

S.2005080 Issued in OH

Practice address

20800 Center Ridge Rd Ste 410
Rocky River, OH 44116-4306

Phone

(440) 356-7620

NPI assigned

Feb 10, 2021

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1612915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612915200000",
    "number": "1376135368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4171 W 226TH ST",
            "city": "FAIRVIEW PARK",
            "state": "OH",
            "postal_code": "441261847",
            "telephone_number": "440-840-2089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20800 CENTER RIDGE RD STE 410",
            "city": "ROCKY RIVER",
            "state": "OH",
            "postal_code": "441164306",
            "telephone_number": "440-356-7620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISTER",
        "first_name": "NICOLE",
        "credential": "LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-10",
        "last_updated": "2021-02-10",
        "certification_date": "2021-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S.2005080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Jean Diffendal, PCC-S
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• Lisa Doane, PH.D.
• Audrey Dolenc
• Jaquita Dorman, LSW
• Samantha Dowling
• Margaret G. Doyle, RD,LD

• Social Worker in Rocky River, OH
• Providers in Rocky River, OH by specialty
• Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 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.