Nicole Christine Crockett, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

150104593 Issued in IL

Practice address

120 N Williams Industrial Dr
Pittsfield, IL 62363-1300

Phone

(217) 285-4436

Fax

(217) 285-2804

NPI assigned

Jul 6, 2021

Last updated

Nov 25, 2022By the provider in NPPES

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 names 1

• Nicole Christine Brix Former name

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": "1625529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669334400000",
    "number": "1497326052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 SE CROSS ST",
            "city": "MT STERLING",
            "state": "IL",
            "postal_code": "623531561",
            "telephone_number": "217-773-3325",
            "fax_number": "217-773-2425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 N WILLIAMS INDUSTRIAL DR",
            "city": "PITTSFIELD",
            "state": "IL",
            "postal_code": "623631300",
            "telephone_number": "217-285-4436",
            "fax_number": "217-285-2804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROCKETT",
        "first_name": "NICOLE",
        "middle_name": "CHRISTINE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-06",
        "last_updated": "2022-11-25",
        "certification_date": "2022-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "150104593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "BRIX",
            "middle_name": "CHRISTINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kendra Jo Conkright, M.D.
• Gwen Ann Corrigan, COTA
• County of Pike (Pike County Health Department)
• County of Pike (Pike County Health Department)
• County of Pike (Pike County Ambulance Service)
• Christina Cunningham
• Dan K. Speckhart D.M.D. and Douglas J. White D.M.D., P.C.
• Jennifer Davidson
• Amelia L. Dean, M.D.
• Marsha Dejaynes

• Clinical Social Worker in Pittsfield, IL
• Providers in Pittsfield, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2022; 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.