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 | 104100000X | Social Worker | | 1026597 | 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 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 2 | 1061933 | OTHER | | CIGNA HEALTH PLAN |
| 3 | 042472266 | OTHER | | THREE RIVERS |
| 4 | P07209 | OTHER | | BLUE SHIELD HMO BLUE |
| 5 | 042472266 | OTHER | | HEALTHCARE VALUE MANAGEME |
| 6 | 2043637 | OTHER | | FIRST HEALTH |
| 7 | 580244000 | OTHER | | MAGELLAN BEHAVIORAL HEALT |
| 8 | 800011108 | OTHER | | RAILROAD MEDICARE |
| 9 | 04247226 | OTHER | | ONE HEALTH PLAN |
| 10 | 33824 | OTHER | | FALLON COMMUNITY HEALTH P |
| 11 | 785946 | OTHER | | MVP HEALTH CARE |
| 12 | P07209 | OTHER | | BLUE SHIELD INDEMNITY |
| 13 | P20253 | OTHER | | MEDICARE B |
| 14 | 042472266006 | OTHER | | TRICARE CHAMPUS |
| 15 | P07209 | OTHER | | BLUE CARE ELECT |
| 16 | 042472266 | OTHER | | PACIFICARE |
| 17 | P20253 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
