Mary Kathryn Nicoll, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

002617 Issued in CT

Practice address

300 Church St Ste 105
Yalesville, CT 06492-2253

Phone

(203) 679-0849

NPI assigned

Apr 3, 2007

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

Other identifiers 1

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

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.

• Soul Friends, Inc

  • Community/Behavioral Health Agency
  • Wallingford, CT
  • NPI 1154499804

  Clinical

  Medicare reassignment NPD
• Yale New Haven Hospital

  • General Acute Care Hospital
  • New Haven, CT
  • NPI 1336139500
  NPD (past)

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336608000000",
    "number": "1376664722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 N BROOKSVALE RD",
            "city": "CHESHIRE",
            "state": "CT",
            "postal_code": "064103336",
            "telephone_number": "203-272-8486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 CHURCH ST STE 105",
            "city": "YALESVILLE",
            "state": "CT",
            "postal_code": "064922253",
            "telephone_number": "203-679-0849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICOLL",
        "first_name": "MARY KATHRYN",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-03",
        "last_updated": "2012-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "002617",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004237352",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peggy Arlene Lane, LCSW
• Evan D McClure, MS, LPC
• Irwin H. Meslin, D.M.D.
• Allison Marie Michaud
• Samantha Miller-Hood, LCSW
• On the Right Trackcounseling LLC
• Jessica E Ray, LPC
• Regenerise Health LLC
• Shayna Marie Shorrock, APRN
• Silvia Sandoval, LCSW

• Clinical Social Worker in Yalesville, CT
• Providers in Yalesville, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2012; 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.