Shawn Marie Niccolls, LCSW
Individual provider Active NPI Clinical Social Worker · Hernando, FL
NPI 1720008071 · NPPES record last updated May 18, 2024
Key facts
- NPI
- 1720008071
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- SW 9197 (FL)
- Practice address
- 8443 N Oak River Way
Hernando, FL 34442-2344 - Phone
- (352) 455-9710
- Fax
- (352) 341-2483
- NPI assigned
- Jul 20, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
8443 N Oak River Way
Hernando, FL 34442-2344
Phone (352) 455-9710
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100806000736 | FL | Practitioner - Clinical Social Worker | 6608909981 | Practice locations: Hernando, FL |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW 9197 | FL | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Serenity Landing Therapy | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | SW 9197 | FL | Yes |
Addresses
Primary practice location
8443 N Oak River Way
Hernando, FL 34442-2344
Mailing address
8443 N Oak River Way
Hernando, FL 34442-2344
Phone (352) 455-9710
Other providers in Hernando, FL
- Jessica Lynn Morales
- John Mosley Jr.
- Liza A. Mozingo
- Myeyedr. Optometry of Florida, LLC
- Anna Elizabeth Newlon
- Matthew Nixon
- Bharat V Parikh
- Won H Park
- Shauna Lori Parrish
- Parshwa LLC
All providers in Hernando, FL · Clinical Social Worker in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.