Nicole M. Pettibone, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6801097713 Issued in MI

Practice address

22255 Greenfield Rd Ste 550
Southfield, MI 48075-3730

Phone

(844) 576-9226

NPI assigned

Apr 15, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

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, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Richard Kneip PHD PCGroup PAC ID 4880768415, 243 clinicians

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.

• Richard Kneip, PH.D., P.C.

  • Community/Behavioral Health Agency
  • Clarkston, MI
  • NPI 1679739700

  MI

  Medicare reassignment Care Compare group NPD
• Henry Ford Health Eastwood Behavioral Health

  • Social Worker
  • Clinton Township, MI
  • NPI 1396787701

  MI, Social Worker

  Medicare reassignment NPD
• Michigan Healthcare Professionals PC

  • Internal Medicine Physician
  • Farmington Hills, MI
  • NPI 1295023547

  MI

  Medicare reassignment NPD
• Seton Health Corporation of Southeastern Michigan

  • Family Medicine Physician
  • Clinton Township, MI
  • NPI 1598177065

  Clinical, MI

  Medicare reassignment NPD
• The Guidance Center

  • Community/Behavioral Health Agency
  • Southgate, MI
  • NPI 1609947027

  MI

  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical, MI

  Medicare reassignment NPD
• Michigan Healthcare Professionals PC

  • Durable Medical Equipment & Medical Supplies
  • Lapeer, MI
  • NPI 1992693303
  NPD
• Seton Health Corporation of Southeastern Michigan

  • Physical Therapy Clinic/Center
  • Macomb, MI
  • NPI 1487067260
  NPD

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

{
    "created_epoch": "1429056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579478400000",
    "number": "1679969752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 LIVERNOIS RD",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480831215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22255 GREENFIELD RD STE 550",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480753730",
            "telephone_number": "844-576-9226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIBONE",
        "first_name": "NICOLE",
        "middle_name": "M.",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-15",
        "last_updated": "2020-01-20",
        "certification_date": "2020-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801097713",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801097713",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF MICHIGAN - MICHIGAN DEPARTMENT OF LICENSING & REGULATORY AFFAIRS",
            "identifier": "6801097713",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vernita Peterson, LLPC
• Tana Pethers
• Sylvia Jeanette Petit, RPH
• Cynthia J Petrack, APRN-BC
• Emanuela Bercea Petrascu, O.D.
• Thomas Bernard Pettus, LLPC, LBS.W.
• Pamela Esther Pettway, LMT
• Kasmire Bao-Tran M Pham, RN, NP STUDENT
• Kathy Thi Y Nhi Pham, PA-C
• Michael Pham, DO

• All providers in Southfield, MI
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 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.
• 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.