Active NPI
Liberty Louise Nicholas, LCSW
- Clinical Social Worker
- San Antonio, TX
National Provider Identifier
1861254575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 55861
- Practice address
- 15514 River BND
San Antonio, TX 78247-2919 - Phone
- (210) 685-0711
- NPI assigned
- Jan 29, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 | 55861 | TX | Primary |
Addresses
Primary practice location
15514 River BND
San Antonio, TX 78247-2919
Mailing address
15514 River BND
San Antonio, TX 78247-2919
Phone (512) 596-5805
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 99-4129751 | Other | TX | PRIVATE THERAPY PRACTICE |
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 |
|---|---|---|---|
| 55861 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1706486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723766400000",
"number": "1861254575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15514 RIVER BND",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782472919",
"telephone_number": "512-596-5805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15514 RIVER BND",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782472919",
"telephone_number": "210-685-0711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLAS",
"first_name": "LIBERTY",
"middle_name": "LOUISE",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-01-29",
"last_updated": "2024-08-16",
"certification_date": "2024-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "55861",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRIVATE THERAPY PRACTICE",
"identifier": "99-4129751",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.