Nicole Danielle Widman, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

120505 Issued in CA

Practice address

34248 Via Santa Rosa
Dana Point, CA 92624-1121

Phone

(844) 268-8412

NPI assigned

Jun 1, 2021

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

Enrolled in CA

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

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

{
    "created_epoch": "1622505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785456000000",
    "number": "1972179828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3857 BIRCH ST # 9105",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926602616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34248 VIA SANTA ROSA",
            "city": "DANA POINT",
            "state": "CA",
            "postal_code": "926241121",
            "telephone_number": "844-268-8412"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3857 Birch St # 9105",
            "address_purpose": "LOCATION",
            "city": "Newport Beach",
            "state": "CA",
            "postal_code": "926602616",
            "country_code": "US",
            "telephone_number": "949-688-3511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIDMAN",
        "first_name": "NICOLE",
        "middle_name": "DANIELLE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-01",
        "last_updated": "2026-07-31",
        "certification_date": "2026-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "120505",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grant Jordan Waggoner, LMFT
• Koh M Watanabe, PHARM.D.
• Wav Wellness and Vitality Inc.
• Laurence David Wellikson, M.D.
• Ashley Westmyer
• Sara Wiens, PA-C
• Tyler Wilkens
• William Nguyen DDS Apc
• Whitney Wilson, P.T.
• Lee Yee Win, M.D.,

• Clinical Social Worker in Dana Point, CA
• Providers in Dana Point, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2026; 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.