Larissa F Nickson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

44SC05537000 Issued in NJ

Practice address

3 3Rd St Ste 20
Bordentown, NJ 08505-1370

Phone

(732) 749-4267

NPI assigned

Aug 24, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Hopeful Horizon Wellness LLC

  • Mental Health Counselor
  • Bordentown, NJ
  • NPI 1720766272
  NPD Authorized official

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

{
    "created_epoch": "1282608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690848000000",
    "number": "1477869865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "381 MCKINLEY AVE",
            "city": "MORRISVILLE",
            "state": "PA",
            "postal_code": "190672359",
            "telephone_number": "732-749-4267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 3RD ST STE 20",
            "city": "BORDENTOWN",
            "state": "NJ",
            "postal_code": "085051370",
            "telephone_number": "732-749-4267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKSON",
        "first_name": "LARISSA",
        "middle_name": "F",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-08-24",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05537000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4144007",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "31-4011",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nancy a. McNamara, D.M.D, P.C.
• Nusreen Kathrada Navarro, LSW
• Shane Neher, DPT, PT
• New Jersey CVS Pharmacy LLC
• Rachael Newman, PT, DPT
• Oasis Healthcare Services LLC
• Gloria O Olatubosun, RN. FNP-BC
• Chika Onunkwo
• Uchenna Chukwudi Onunkwo
• Brianna Pagnani, OTR/L

• Clinical Social Worker in Bordentown, NJ
• Providers in Bordentown, NJ by specialty
• Clinical Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 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.

Verify at the official NPI Registry.