Nicole Paige Burnside, LCSW, CWEL

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.029857 Issued in IL

Practice address

701 Grand Ave
Waukegan, IL 60085-4109

Phone

(847) 242-1126

NPI assigned

Aug 8, 2025

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Mimi'S House Family Advocacy Center NFP

  • Clinical Social Worker
  • Waukegan, IL
  • NPI 1952256174
  NPD (past)

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

{
    "created_epoch": "1754611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754611200000",
    "number": "1902781982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 GRAND AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600854109",
            "telephone_number": "847-242-1126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 GRAND AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600854109",
            "telephone_number": "847-242-1126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURNSIDE",
        "first_name": "NICOLE",
        "middle_name": "PAIGE",
        "name_prefix": "Mrs.",
        "credential": "LCSW, CWEL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-08-08",
        "last_updated": "2025-08-08",
        "certification_date": "2025-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.029857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Marie Brumund, M.D.
• Deborah L Brunder, RN
• Duyen Bui
• Ferdinand Bundang, PT
• Daniel Burgos, LPC
• Megan Burton
• Revell Burton, CADC AAS
• Jaquez Busby
• Christopher Butler Sr.
• Margaret Jo Butler, LPC

• Clinical Social Worker in Waukegan, IL
• Providers in Waukegan, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2025; 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.