Nicaeli Grace Theobald, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

5638 Professional Cir
Indianapolis, IN 46241-5042

Phone

(888) 714-1927

NPI assigned

Jun 23, 2022

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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.

• Cummins Behavioral Health Systems, Incorporated

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Avon, IN
  • NPI 1740232115
  NPD

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

{
    "created_epoch": "1655942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742774400000",
    "number": "1730810342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5241 W 15TH ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462246415",
            "telephone_number": "317-987-4018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5638 PROFESSIONAL CIR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462415042",
            "telephone_number": "888-714-1927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEOBALD",
        "first_name": "NICAELI",
        "middle_name": "GRACE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-23",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arun Thekkekarott Thekkekarott Kuruvila, M.D
• Sanjay Vijaya Thekkeurumbil, MD
• Georgia Thelen
• Julia Thelen
• Dale E. Theobald, M.D., PH.D.
• Noah Theobald
• Karrie Ann Hines Theoharis, CGC
• Nate Thepjatri, MD
• Theracare
• Theranostix Inc

• Clinical Social Worker in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2025; 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.