Provider Demographics
NPI:1871854109
Name:VERGELDEDIOS, NICOLE (LMSW, LISW)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:VERGELDEDIOS
Suffix:
Gender:F
Credentials:LMSW, LISW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:VARGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:618 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1248
Mailing Address - Country:US
Mailing Address - Phone:937-935-5208
Mailing Address - Fax:
Practice Address - Street 1:618 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1248
Practice Address - Country:US
Practice Address - Phone:937-935-5208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.15023321041C0700X
MI68011175961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1473276Medicaid