Individual provider Active NPI

Donna Marie Nicolino, MSW

  • Clinical Social Worker
  • Willimantic, CT
National Provider Identifier
1376568386
Registry record updated Dec 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
91 South St
Apt 1
Willimantic, CT 06226-3455
Phone
(860) 456-2261
Fax
(860) 450-1357
NPI assigned
Jul 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

91 South St
Apt 1
Willimantic, CT 06226-3455

Mailing address

91 South St
Apt 1
Willimantic, CT 06226-3455
Phone (347) 727-8865

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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

Enrollment IDStateProvider typePAC IDDetails
I20080219000325 CT Practitioner - Clinical Social Worker 5395828065 Practice locations: Willimantic, CT

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

25 Summit St
Willimantic, CT 06226-2827
Phone (347) 727-8865

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6637CTMDProfessional Counselor

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608508800000",
    "number": "1376568386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "91 SOUTH ST",
            "address_2": "APT 1",
            "city": "WILLIMANTIC",
            "state": "CT",
            "postal_code": "062263455",
            "telephone_number": "347-727-8865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91 SOUTH ST",
            "address_2": "APT 1",
            "city": "WILLIMANTIC",
            "state": "CT",
            "postal_code": "062263455",
            "telephone_number": "860-456-2261",
            "fax_number": "860-450-1357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICOLINO",
        "first_name": "DONNA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-12",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willimantic, CT

Sources for this page

Verify at the official NPI Registry.