Carol Nickles, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2843-123 Issued in WI

Practice address

401 Wisconsin Ave
Madison, WI 53703-1487

Phone

(608) 256-5115

Fax

(608) 256-5116

NPI assigned

Aug 8, 2016

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

Enrolled in WI

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, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Moontree Psychotherapy Center LLCGroup PAC ID 3274660295, 11 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.

• Moontree Psychotherapy Center LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Madison, WI
  • NPI 1770806259
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1470614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470614400000",
    "number": "1780138776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 WISCONSIN AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537031487",
            "telephone_number": "608-256-5115",
            "fax_number": "608-256-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 WISCONSIN AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537031487",
            "telephone_number": "608-256-5115",
            "fax_number": "608-256-5116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKLES",
        "first_name": "CAROL",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-08",
        "last_updated": "2016-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "2843-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Thomas Nickel, M.D.
• Clara Nickel
• Ellen Puskala Nickel, APRN
• Juanita Nickelson
• Nickles Counseling, LLC
• Peter J Nicksic, MD
• Victoria Brocksmith Nicksic, MD
• Elsa Nico, MD
• Nancy Nicolai, DPT
• Brandon Scott Nidea, MD

• Clinical Social Worker in Madison, WI
• Providers in Madison, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2016; 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.