Nicole Marie Prust, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801110599 Issued in MI

Practice address

103 W US Highway 2
Wakefield, MI 49968-9515

Phone

(906) 229-6120

NPI assigned

Oct 16, 2017

Last updated

Jul 26, 2021By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in MI

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

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gogebic County Community Mental Health Authority

  • Mental Health Counselor
  • Wakefield, MI
  • NPI 1912957143

  Social Worker

  Medicare reassignment NPD

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

{
    "created_epoch": "1508112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627257600000",
    "number": "1902317019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "343 W SOUTHLAND AVE",
            "city": "IRONWOOD",
            "state": "MI",
            "postal_code": "499381066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 W US HIGHWAY 2",
            "city": "WAKEFIELD",
            "state": "MI",
            "postal_code": "499689515",
            "telephone_number": "906-229-6120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUST",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-10-16",
        "last_updated": "2021-07-26",
        "certification_date": "2021-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801101923",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801110599",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Parker, LLPC
• Sandra Colleen Pera, C.P.M., L.M.
• Angie M Perry
• Dustin Pitrone
• Kristina Leeann Potesta
• Cindy Rand
• Angel Star Robles
• James Emil Rocco, M.D.
• Lee Rosenberg
• Michael D Rubatt, LLMSW

• Clinical Social Worker in Wakefield, MI
• Providers in Wakefield, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2021; 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.