Active NPI
Nicole Reynolds Small, MSW, LICSW
- Clinical Social Worker
- Mount Vernon, WA
National Provider Identifier
1417072356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LW 60064972
- Practice address
- 1005 S 3Rd St
Mount Vernon, WA 98273-4301 - Phone
- (360) 419-3612
- Fax
- (360) 419-3605
- NPI assigned
- Mar 20, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | ASW18384 | CA | |
| School Social Worker | 1041S0200X | PPSC #060034254 | CA | |
| Counselor | 101Y00000X | RC00058160 | WA | |
| School Social Worker | 1041S0200X | 443673R | WA | |
| Clinical Social Worker | 1041C0700X | LW 60064972 | WA | Primary |
Addresses
Primary practice location
1005 S 3Rd St
Mount Vernon, WA 98273-4301
Mailing address
1701 30TH St
Bellingham, WA 98225-7603
Phone (310) 210-8662
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSIX593 | Other | CA | DMH |
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 |
|---|---|---|---|
| RC00058160 | WA | MD | Counselor |
| ASW18384 | CA | MD | Clinical Social Worker |
| LW 60064972 | WA | MD | Clinical Social Worker |
| PPSC #060034254 | CA | MD | School Social Worker |
| 443673R | WA | MD | School Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1263945600000",
"number": "1417072356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1701 30TH ST",
"city": "BELLINGHAM",
"state": "WA",
"postal_code": "982257603",
"telephone_number": "310-210-8662"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1005 S 3RD ST",
"city": "MOUNT VERNON",
"state": "WA",
"postal_code": "982734301",
"telephone_number": "360-419-3612",
"fax_number": "360-419-3605"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMALL",
"first_name": "NICOLE",
"middle_name": "REYNOLDS",
"credential": "MSW, LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-20",
"last_updated": "2010-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "ASW18384",
"primary": false
},
{
"code": "1041S0200X",
"taxonomy_group": "",
"desc": "Social Worker, School",
"state": "CA",
"license": "PPSC #060034254",
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WA",
"license": "RC00058160",
"primary": false
},
{
"code": "1041S0200X",
"taxonomy_group": "",
"desc": "Social Worker, School",
"state": "WA",
"license": "443673R",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WA",
"license": "LW 60064972",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMH",
"identifier": "PSIX593",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mount Vernon, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.