Nicole Phillips

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

300 Church St
Wallingford, CT 06492-2253

Phone

(203) 676-4030

NPI assigned

Sep 14, 2016

Last updated

May 23, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Interoperability endpoints

• Direct secure messaging: nicole.fonda.p1@direct.wheelerclinic.nextgenshare.com

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

{
    "created_epoch": "1473811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653264000000",
    "number": "1881142230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 CHURCH ST",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064922253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 CHURCH ST",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064922253",
            "telephone_number": "203-676-4030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-14",
        "last_updated": "2022-05-23",
        "certification_date": "2022-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881142240",
            "state": "CT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "SoulFriends",
            "affiliation": "N",
            "address_1": "300 Church St",
            "city": "Wallingford",
            "state": "CT",
            "country_code": "US",
            "postal_code": "064922253",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Stephanie Pesapane, RDN
• Karen Pettit, RPT
• Pharmacy and Therapeutics Consulting, Inc.
• Pharmacy Corporation of America (OnePoint Patient Care)
• Pharmacy Corporation of America (Pharmerica)
• Phoenix Therapy Services, LLC
• Lisa Phung, SLP
• Bonnie M Piascyk, APRN
• Francisco John Pimentel, O.D.
• Emily Pindar, ATC

• Clinical Social Worker in Wallingford, CT
• Providers in Wallingford, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.