Denise Marie Nickerson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LC7406 Issued in ME

Practice address

336 Mount Hope Ave Ste 17
Bangor, ME 04401-4236

Phone

(207) 573-9011

Fax

(207) 922-9847

NPI assigned

Apr 23, 2007

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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585872000000",
    "number": "1568680445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "336 MOUNT HOPE AVE STE 17",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014236",
            "telephone_number": "207-573-9011",
            "fax_number": "207-922-9847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "336 MOUNT HOPE AVE STE 17",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014236",
            "telephone_number": "207-573-9011",
            "fax_number": "207-922-9847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKERSON",
        "first_name": "DENISE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-23",
        "last_updated": "2020-04-03",
        "certification_date": "2020-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC7406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "327150099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mai Huong Thi Nguyen, LCSW
• Edward P. Nicholas, M.D.
• Karolyn Nicholas, MD
• Karen E. Nichols, PA-C
• Brandi Lyon Nickerson, PA-C
• Katherine Dawn Nickerson, O.D.
• Meisha B Nickerson, LCSW
• John Nicolet, MD
• Heidi L Niles, DPT
• Joyce E Niles, NP

• Clinical Social Worker in Bangor, ME
• Providers in Bangor, ME by specialty
• Clinical Social Worker in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2020; 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.