Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 1041C0700X | Social Worker | Clinical | 0104653 | MASSACHUSETTS | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 1014950 | OTHER | MASSACHUSETTS | FALLON ID # |
| 2 | 4212987 | OTHER | MASSACHUSETTS | AETNA ID # |
| 3 | P50031 | OTHER | MASSACHUSETTS | BCBS INDIVIDUAL ID # |
| 4 | A021518 | OTHER | MASSACHUSETTS | VALUE OPTIONS ID NUMBER |
| 5 | P21992 | MEDICARE UPIN | MASSACHUSETTS | |
| 6 | 684200 | OTHER | MASSACHUSETTS | BEACON HS |
| 7 | P10260 | OTHER | MASSACHUSETTS | BCBS MA GROUP ID # |
| 8 | P21992 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | INDIVIDUAL IDENTIFIER |
| 9 | P30154 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | GROUP IDENTIFIER |
| 10 | 004112 | OTHER | MASSACHUSETTS | VALUE OPTIONS INDIV ID # |
| 11 | 1039062 | OTHER | MASSACHUSETTS | CIGNA ID # |
