Active NPI
Nicole G Derisi
- Clinical Social Worker
- Edison, NJ
National Provider Identifier
1831843010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- RBT-21-198035
- Practice address
- 2035 Lincoln Hwy Ste 1150
Edison, NJ 08817-3351 - Phone
- (866) 557-8669
- NPI assigned
- Feb 7, 2022
- Reactivated
- Jul 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 | RBT-21-198035 | NJ | Primary |
Addresses
Primary practice location
2035 Lincoln Hwy Ste 1150
Edison, NJ 08817-3351
Mailing address
293 Colonia Blvd
Colonia, NJ 07067-3025
Phone (732) 675-1868
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 |
|---|---|---|---|
| RBT-21-198035 | NJ | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1644192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783296000000",
"number": "1831843010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "293 COLONIA BLVD",
"city": "COLONIA",
"state": "NJ",
"postal_code": "070673025",
"telephone_number": "732-675-1868"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2035 LINCOLN HWY STE 1150",
"city": "EDISON",
"state": "NJ",
"postal_code": "088173351",
"telephone_number": "866-557-8669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERISI",
"first_name": "NICOLE",
"middle_name": "G",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-02-07",
"last_updated": "2026-07-06",
"certification_date": "2026-07-06",
"deactivation_date": "2026-05-27",
"reactivation_date": "2026-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NJ",
"license": "RBT-21-198035",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edison, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 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.