Kimberly Nelson, LCSW

Key facts

NPI

1750430708

Entity type

Individual (NPI type 1)

Primary specialty

Clinical Social Worker 1041C0700X

License

003250 (CT)

Practice address

97 Woodsvale Rd
Madison, CT 06443-1749

Phone

(203) 421-4134

NPI assigned

Jan 9, 2007

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Interoperability endpoints

• Direct secure messaging: kimberly.nelson.p1@direct.wheelerclinic.nextgenshare.com

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1750430708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "97 WOODSVALE RD",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064431749",
            "telephone_number": "203-421-4134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "97 WOODSVALE RD",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064431749",
            "telephone_number": "203-421-4134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "KIMBERLY",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "003250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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