Nicole Marie Anderson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

28443 Issued in CA

Practice address

6136 Mission Gorge Rd Ste 106
San Diego, CA 92120-3413

Phone

(619) 786-1351

NPI assigned

Aug 26, 2007

Last updated

Apr 14, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1188086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586822400000",
    "number": "1679766380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4784 34TH ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921161832",
            "telephone_number": "619-786-1351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6136 MISSION GORGE RD STE 106",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921203413",
            "telephone_number": "619-786-1351"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1202 Morena Blvd Ste 300",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921103844",
            "country_code": "US",
            "telephone_number": "619-275-0822",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-26",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "28443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan C Anderson, PHD
• Melina Anderson
• Michael Anderson, D.C.
• Morgan Anderson
• Nancy Porter Anderson, LAC
• Nicole Marie Anderson, PT
• Patience Diyana Anderson
• Quinn Anderson
• Renee Lea Anderson, M.A., BCBA
• Robin Lee Anderson, LMFT

• Clinical Social Worker in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.