Jonathan Richard Nelson III, LCSW, MCAP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW12912 Issued in FL

Practice address

900 N Swallow Tail Dr Ste 105
Port Orange, FL 32129-6103

Phone

(386) 333-9717

NPI assigned

Sep 5, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1536105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536969600000",
    "number": "1629550744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 N SWALLOW TAIL DR STE 105",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321296103",
            "telephone_number": "386-333-9717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 N SWALLOW TAIL DR STE 105",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321296103",
            "telephone_number": "386-333-9717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "JONATHAN",
        "middle_name": "RICHARD",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "LCSW, MCAP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-09-05",
        "last_updated": "2018-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "FL",
            "license": "SW12912",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW12912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lara J. Nance, ANP
• Lakshmi Prathyusha Nannapaneni, DDS
• Sandra Elizabeth Navas Lopez, MS CCC-SLP
• Andres Oscar Nazario, DC
• Tonya W Neimeic, MA, CCC-SLP-L
• Kimberly Nelson
• Tionne Nelson
• John Nesbitt Jr.
• Alexander Nescott
• Neurology & Spine Disorders LLC

• Clinical Social Worker in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2018; 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.