Nicole Simone Samuels, LCSW, LADC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

014306 Issued in CT

Practice address

63 Trinity St
New Britain, CT 06051-3416

Phone

(718) 501-7272

NPI assigned

Mar 13, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

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.

• Revive Wellness LLC

  • Clinical Social Worker
  • Naugatuck, CT
  • NPI 1235884073
  NPD (past)

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

{
    "created_epoch": "1552435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727308800000",
    "number": "1942769633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 TRINITY ST",
            "city": "NEW BRITAIN",
            "state": "CT",
            "postal_code": "060513416",
            "telephone_number": "718-501-7272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 TRINITY ST",
            "city": "NEW BRITAIN",
            "state": "CT",
            "postal_code": "060513416",
            "telephone_number": "718-501-7272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUELS",
        "first_name": "NICOLE",
        "middle_name": "SIMONE",
        "credential": "LCSW, LADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-13",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "105078",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "014306",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CT",
            "license": "001526",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ike A Sammy
• Andrew Sampiere, LCSW
• Ann Brennan Samson, OTD, OTR/L
• Todd A. Samter, MD
• Mariah Samuels, LCSW
• Peter San, LCSW
• Harold Sanchez, M.D.
• Jazline M Sanchez, LMFT
• Nathalie Sanchez
• Amy Sandberg, LCSW

• Clinical Social Worker in New Britain, CT
• Providers in New Britain, 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 Sep 26, 2024; 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.