Individual provider Active NPI

Nicole Sophia Froman, LCSW

  • Clinical Social Worker
  • Fort Collins, CO
National Provider Identifier
1609466614
Registry record updated Jan 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CSW.09926788 Issued in CO
Practice address
4312 Shadowbrook CT
Fort Collins, CO 80526-3445
Phone
(970) 420-8444
NPI assigned
Jan 23, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X CSW.09926788 CO Primary

Addresses

Primary practice location

4312 Shadowbrook CT
Fort Collins, CO 80526-3445

Mailing address

4312 Shadowbrook CT
Fort Collins, CO 80526-3445
Phone (970) 420-8444

Other names 1

  • Miss Nicole Sophia Russell Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20230821000653 CO Practitioner - Clinical Social Worker 2769844182 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CSW.09926788COMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Inner Shell Therapy LLC CurrentSince Jul 1, 2023 Accepting new patients

Locations

2620 E Prospect Rd
Ste 160
Fort Collins, CO 80525
Phone (970) 221-1919

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1611360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611360000000",
    "number": "1609466614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4312 SHADOWBROOK CT",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805263445",
            "telephone_number": "970-420-8444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4312 SHADOWBROOK CT",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805263445",
            "telephone_number": "970-420-8444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FROMAN",
        "first_name": "NICOLE",
        "middle_name": "SOPHIA",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-23",
        "last_updated": "2021-01-23",
        "certification_date": "2021-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "CSW.09926788",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "RUSSELL",
            "middle_name": "SOPHIA",
            "prefix": "MISS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.