Katrina Mary Nichols, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

121724 Issued in MA

Practice address

456 Flax Pond Rd
Brewster, MA 02631-2133

Phone

(604) 801-2386

NPI assigned

Jun 12, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Katrina Mary Nickerson Former name

Medicare fee-for-service enrollment

Enrolled in MA

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

Specialty

Clinical Social Worker

Education

Other, 2013

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Oria LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Hyannis, MA
  • NPI 1841825320
  Medicare reassignment NPD

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

{
    "created_epoch": "1528761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568332800000",
    "number": "1659864890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "237 OLD MILL RD",
            "city": "MARSTONS MILLS",
            "state": "MA",
            "postal_code": "026481054",
            "telephone_number": "603-801-2386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "456 FLAX POND RD",
            "city": "BREWSTER",
            "state": "MA",
            "postal_code": "026312133",
            "telephone_number": "604-801-2386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "KATRINA",
        "middle_name": "MARY",
        "name_prefix": "Mrs.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-12",
        "last_updated": "2019-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "ISW02639",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "121724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATRINA",
            "last_name": "NICKERSON",
            "middle_name": "MARY",
            "credential": "LICSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mind Body Spine Chiropractic Inc
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• Julie Lynne Mollica, LICENSED INDEPENDENT
• Nancy J. Sweeney, Ma, LMHC, Inc.
• Angela Nash Hennemuth, LICSW
• Allison Noyes, OTR/L
• Thomas Francis Obrien, MA MSW LICSW
• Michele Louise Oconnor, OTR/L
• Out of the Ash LLC
• Michele Pavlu, ATC, LAT

• Clinical Social Worker in Brewster, MA
• Providers in Brewster, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.