Nicole Gordon, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-17933 Issued in AZ

Practice address

10000 N 31St Ave Ste D407
Phoenix, AZ 85051-1352

Phone

(602) 718-1266

NPI assigned

Sep 24, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AZ

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

Medicare enrollment (NPD)

Enrolled

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.

• Best Self LLC

  • Community/Behavioral Health Agency
  • Phoenix, AZ
  • NPI 1609475144
  Medicare reassignment NPD Authorized official
• Phoenix Children's Hospital

  dba Phoenix Children's Medical Group

  • Pediatrics Physician
  • Phoenix, AZ
  • NPI 1922112044
  Medicare reassignment NPD
• Sondermind Provider Network LLC

  • Clinical Social Worker
  • Denver, CO
  • NPI 1760854442

  AZ

  Medicare reassignment NPD
• Phoenix Children's Medical Group

  • Multi-Specialty Clinic/Center
  • Mesa, AZ
  • NPI 1487814240
  NPD
• Phoenix Children's Medical Group

  • Multi-Specialty Clinic/Center
  • Glendale, AZ
  • NPI 1679703441
  NPD

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

{
    "created_epoch": "1569283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689811200000",
    "number": "1871144535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6537 N 55TH AVE # 473",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853013959",
            "telephone_number": "602-718-1266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10000 N 31ST AVE STE D407",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850511352",
            "telephone_number": "602-718-1266"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5646 E Main St",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852058800",
            "country_code": "US",
            "telephone_number": "404-513-0324",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "NICOLE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-24",
        "last_updated": "2023-07-20",
        "certification_date": "2023-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "AZ",
            "license": "LCSW-17933",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "LCSW-17933",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "087415",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000710",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Nicole@bestselfllc.com",
            "affiliation": "N",
            "endpointDescription": "Email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Connection information",
            "address_1": "7609 W Rovey Ave",
            "city": "Glendale",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "853034250",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kadirah Gordon
• Karen Gordon, LCSW
• Kristopher Gordon
• Matthew Ronald Gordon, LCSW
• Michael H Gordon, MD
• Rachel Gordon, LMT
• Ramsey D Gordon, D.C.
• Richard Joseph Gordon, MD
• Robert K Gordon, DO
• Ronald D Gordon, MD

• Clinical Social Worker in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Clinical Social Worker in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.