Nicole Woller, PH.D., LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW8553 Issued in FL

Practice address

5818 SE Agnew Rd
Belleview, FL 34420-4020

Phone

(561) 706-1004

Fax

(561) 892-0268

NPI assigned

Feb 11, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Networks

• Freedom Health HMO Network

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.

• Pediatric Behavioral Health Associates, Inc.

  • Clinical Social Worker
  • Belleview, FL
  • NPI 1861953523

  Psychologist

  NPD (past)

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

{
    "created_epoch": "1171152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587513600000",
    "number": "1881735819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2735 SE 140TH PL",
            "city": "SUMMERFIELD",
            "state": "FL",
            "postal_code": "344912877",
            "telephone_number": "561-715-5910",
            "fax_number": "561-892-0268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5818 SE AGNEW RD",
            "city": "BELLEVIEW",
            "state": "FL",
            "postal_code": "344204020",
            "telephone_number": "561-706-1004",
            "fax_number": "561-892-0268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLLER",
        "first_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "PH.D., LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-11",
        "last_updated": "2020-04-22",
        "certification_date": "2020-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW8553",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11758162",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "767023100",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "DRWOLLER@PBHI.ORG",
            "affiliation": "N",
            "endpointDescription": "DIREXT SECURE EMAIL",
            "address_1": "5818 SE Agnew Rd",
            "city": "Belleview",
            "state": "FL",
            "country_code": "US",
            "postal_code": "344204020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Devin Wilkes
• Caremma Erica Williams
• Trang Williams, DOULA
• Laranda Wilson
• Jessica Rose Wolf
• Christopher Woodard
• Montiel Woods
• WP Group Inc
• Kaitlyn Yearout
• Aimee Zapata-Chaux

• Clinical Social Worker in Belleview, FL
• Providers in Belleview, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2020; 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.