Nikole Boston, LCSW
Individual provider Active NPI Clinical Social Worker · Shade Gap, PA
NPI 1720599434 · NPPES record last updated Aug 4, 2021
Key facts
- NPI
- 1720599434
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- CW019868 (PA)
- Practice address
- 11891 Neelyton Rd
Shade Gap, PA 17255-9247 - Phone
- (717) 489-2949
- NPI assigned
- Oct 20, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- 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 |
|---|---|---|---|---|
| I20200618001343 | PA | Practitioner - Clinical Social Worker | 3971925074 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW134830 | PA | MD | Social Worker |
| CW019868 | PA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Mindful Oasis Co. | Clinical | Current |
Accepting new patients |
| Behavioral Health and Wellness Associates LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | SW134830 | PA | |
| Clinical Social Worker | 1041C0700X | CW019868 | PA | Yes |
Addresses
Primary practice location
11891 Neelyton Rd
Shade Gap, PA 17255-9247
Mailing address
11891 Neelyton Rd
Shade Gap, PA 17255-9247
Phone (717) 489-2949
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | nikole@themindfuloasis.com |
Other providers in Shade Gap, PA
All providers in Shade Gap, PA · Clinical Social Worker in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 4, 2021. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.