Nicole Marie Stark, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34007088A Issued in IN

Practice address

66 West St
Pittsfield, MA 01201-5861

Phone

(413) 343-4264

NPI assigned

Jun 11, 2012

Last updated

Aug 8, 2024By 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 2

Addresses

Other names 1

• Nicole Marie Rush Former name

Medicare fee-for-service enrollment

Enrolled in IN, MA, KY3 enrollments

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 3

Specialty

Clinical Social Worker

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Be Authentic Indy LLCGroup PAC ID 7618341496, 8 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Be Authentic Indy LLC

  dba Ellie Mental Health

  • Clinical Social Worker
  • Indianapolis, IN
  • NPI 1841901022
  Medicare reassignment Care Compare group NPD
• Authentic Practice LLC

  dba Ellie Mental Health

  • Clinical Social Worker
  • Pittsfield, MA
  • NPI 1508694605
  Medicare reassignment NPD
• Mental Harmony LLC

  dba Ellie Mental Health

  • Mental Health Counselor
  • Crestview Hills, KY
  • NPI 1083325682
  Medicare reassignment NPD
• Mental Health Specialty Group PA

  dba Rula Health

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  IN

  Medicare reassignment NPD
• Phoenix Rising Mental Health Group LLC

  • Adult Mental Health Clinic/Center
  • Greenwood, IN
  • NPI 1649130055
  NPD Authorized official

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

{
    "created_epoch": "1339372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723075200000",
    "number": "1528320181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8606 ALLISONVILLE RD STE 120",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462503585",
            "telephone_number": "317-951-9358",
            "fax_number": "317-663-2524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 WEST ST",
            "city": "PITTSFIELD",
            "state": "MA",
            "postal_code": "012015861",
            "telephone_number": "413-343-4264"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4020 W Goeller Blvd",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "IN",
            "postal_code": "472018273",
            "country_code": "US",
            "telephone_number": "812-408-8442",
            "fax_number": "317-663-2524",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8606 Allisonville Rd Ste 120",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462503585",
            "country_code": "US",
            "telephone_number": "317-951-9358",
            "fax_number": "317-663-2524",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STARK",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-11",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "LICSW128164",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34007088A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "RUSH",
            "middle_name": "MARIE",
            "credential": "MSW, LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Seema Srinivasa Raju, MD
• Jeffrey L St John, M.D.
• Michael A. Stamm, MD
• Janet G Stanton, NP
• Sean Stanton
• Scott Johnston Steele, MSW
• Jay P Steinhardt
• Ronald Stephens
• Margaret Stephenson, PH.D.
• Maria E. Stern

• Clinical Social Worker in Pittsfield, MA
• Providers in Pittsfield, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.