NPIMap

Organization Active NPI

Willow Tree Wellness & Counseling, LLC

  • Clinical Social Worker
  • Bloomsburg, PA
National Provider Identifier
1649521584
Registry record updated Oct 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CW017138 Issued in PA
Legal business name
WILLOW TREE WELLNESS & COUNSELING, LLC
Practice address
214 Center St
Bloomsburg, PA 17815-1752
Phone
(570) 336-9921
Fax
(570) 317-2594
NPI assigned
Oct 1, 2012
Last updated
Oct 1, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2012

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

Authorized official

Name
Nicole Iacovoni, LCSW, MSWNPI 1578834784
Title
Founder & Chief Clinician
Phone
(570) 336-9921

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X CW017138 PA Primary

Addresses

Primary practice location

214 Center St
Bloomsburg, PA 17815-1752

Mailing address

214 Center St
Bloomsburg, PA 17815-1752
Phone (570) 336-9921

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231211002386 PA Part B Supplier - Clinic/Group Practice 6103275508 Receives reassigned benefits from 5 practitioners
Practice locations: Bloomsburg, PA

National Provider Directory

National Provider Directory

Locations

214 Center St
Bloomsburg, PA 17815
Phone (570) 204-9302

410 Mill St
Orangeville, PA 17859

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1349049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349049600000",
    "number": "1649521584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 CENTER ST",
            "city": "BLOOMSBURG",
            "state": "PA",
            "postal_code": "178151752",
            "telephone_number": "570-336-9921",
            "fax_number": "570-317-2594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 CENTER ST",
            "city": "BLOOMSBURG",
            "state": "PA",
            "postal_code": "178151752",
            "telephone_number": "570-336-9921",
            "fax_number": "570-317-2594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW TREE WELLNESS & COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-01",
        "last_updated": "2012-10-01",
        "status": "A",
        "authorized_official_last_name": "IACOVONI",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "FOUNDER & CHIEF CLINICIAN",
        "authorized_official_telephone_number": "570-336-9921",
        "authorized_official_credential": "LCSW, MSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW017138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomsburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.