Active NPI
Nicolle Ilizarov
- Clinical Social Worker
- Brooklyn, NY
National Provider Identifier
1801746565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 126964
- Practice address
- 541 Bay Ridge Pkwy Ste LL
Brooklyn, NY 11209-3309 - Phone
- (929) 200-3049
- NPI assigned
- Feb 2, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 126964 | NY | Primary |
Addresses
Primary practice location
541 Bay Ridge Pkwy Ste LL
Brooklyn, NY 11209-3309
Mailing address
2820 Ocean Pkwy Apt 10G
Brooklyn, NY 11235-7936
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 126964 | NY | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Resilient Mind Licensed Clinical Social Work Services, PC | Clinical | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Social Worker
- Brooklyn, NY
- NPI 1871136564
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1769990400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1769990400000",
"number": "1801746565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2820 OCEAN PKWY APT 10G",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112357936"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "541 BAY RIDGE PKWY STE LL",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112093309",
"telephone_number": "929-200-3049"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ILIZAROV",
"first_name": "NICOLLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-02-02",
"last_updated": "2026-02-02",
"certification_date": "2026-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "126964",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.