Nicole Lynne Davis

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149015588 Issued in IL

Practice address

4507 N Ravenswood Ave Ste 111
Chicago, IL 60640-5218

Phone

(248) 320-6435

NPI assigned

Sep 14, 2018

Sex

Female

Sole proprietor

Yes

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.

• Balanced Mind Therapy

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1295324671
  NPD (past)

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

{
    "created_epoch": "1536883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536883200000",
    "number": "1972086957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 S MICHIGAN AVE APT 2804",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606164860",
            "telephone_number": "248-320-6435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4507 N RAVENSWOOD AVE STE 111",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405218",
            "telephone_number": "248-320-6435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "NICOLE",
        "middle_name": "LYNNE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-14",
        "last_updated": "2018-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149015588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monique Diene Davis
• Myriam P Davis
• Nathan Davis, MD
• Nathia Davis, APRN
• Nicholas Davis
• Nicole R Davis, RPH
• Nneka Davis, MSN, FNP-BC
• Olivia Davis
• Orlando Davis, L.C.S.W.
• Pamela F Davis

• Clinical Social Worker in Chicago, IL
• Providers in Chicago, 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 Sep 14, 2018; 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.