Nicole Derobertis, LCSW, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

007800 Issued in CT

Legal business name

NICOLE DEROBERTIS, LCSW, LLC

Practice address

245 Amity Rd Ste 209
Woodbridge, CT 06525-2274

Phone

(203) 644-0557

Fax

(203) 504-7941

NPI assigned

Nov 12, 2015

Last updated

Sep 8, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nicole Derobertis, LCSWNPI 1235324567

Title

Owner

Phone

(203) 644-0557

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nicole Marie Derobertis, LCSW

  • Clinical Social Worker
  • Woodbridge, CT
  • NPI 1235324567
  NPD Authorized official

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

{
    "created_epoch": "1447286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725753600000",
    "number": "1982077947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15A INDIAN RIDGE RD",
            "city": "YARMOUTH",
            "state": "ME",
            "postal_code": "040967135",
            "telephone_number": "203-644-0557",
            "fax_number": "203-504-7941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 AMITY RD STE 209",
            "city": "WOODBRIDGE",
            "state": "CT",
            "postal_code": "065252274",
            "telephone_number": "203-644-0557",
            "fax_number": "203-504-7941"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "57 Exchange St Ste 403",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "ME",
            "postal_code": "041015000",
            "country_code": "US",
            "telephone_number": "203-644-0557",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NICOLE DEROBERTIS, LCSW, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-12",
        "last_updated": "2024-09-08",
        "certification_date": "2024-09-08",
        "status": "A",
        "authorized_official_last_name": "DEROBERTIS",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-644-0557",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "007800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008062842",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elisabeth M Mordecai, OTR/L
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• New Haven Dental Group
• Helen Noble
• Asmaa Ali Nofal, RPH
• Angeles E Ocson-Belleza, MD
• Chukwuemeka B. Okwuosa, MA, LADC, ATSA
• Melissa Lynn Olive, PH.D., BCBA-D

• Clinical Social Worker in Woodbridge, CT
• Providers in Woodbridge, 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 8, 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.