Individual provider Active NPI

Nicole M Miller, LCSW

  • Clinical Social Worker
  • Bronx, NY
National Provider Identifier
1568649416
Registry record updated Jun 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
078833 Issued in NY
Practice address
1276 Fulton Ave
Cpep/MCT
Bronx, NY 10456-3402
Phone
(718) 901-8870
Fax
(718) 901-8864
NPI assigned
Jan 23, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2012

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 074218-1 NY
Clinical Social Worker 1041C0700X 0904006925 VA
Clinical Social Worker 1041C0700X 078833 NY Primary

Addresses

Primary practice location

1276 Fulton Ave
Cpep/MCT
Bronx, NY 10456-3402

Mailing address

1276 Fulton Ave
Cpep/MCT
Bronx, NY 10456-3402
Phone (718) 901-8870

Other identifiers 1

IdentifierTypeStateIssuer
01079267MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20170920001971 NY Practitioner - Clinical Social Worker 5496819138 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
074218-1NYMDSocial Worker
078833NYMDClinical Social Worker
0904006925VAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Bronxcare Health System Clinical CurrentSince Mar 24, 2025 Accepting new patients
Colonial Behavioral Health Past Accepting new patients

Locations

1265 Franklin Ave
Fl 6
Bronx, NY 10456

1650 Grand Concourse
Bronx, NY 10457
Phone (718) 294-7104

1276 Fulton Ave
Bronx, NY 10456
Phone (718) 518-5000

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1201046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339459200000",
    "number": "1568649416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1276 FULTON AVE",
            "address_2": "CPEP/MCT",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104563402",
            "telephone_number": "718-901-8870",
            "fax_number": "718-901-8864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1276 FULTON AVE",
            "address_2": "CPEP/MCT",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104563402",
            "telephone_number": "718-901-8870",
            "fax_number": "718-901-8864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "NICOLE",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-23",
        "last_updated": "2012-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "074218-1",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904006925",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "078833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01079267",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.