Jacqueline Bango, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

120046 Issued in MA

Practice address

55 Fruit Street
Founders Building Suite 880
Boston, MA 02114

Phone

(617) 643-8281

NPI assigned

Nov 13, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: jacqueline.bango.1@18731.direct.athenahealth.com

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

{
    "created_epoch": "1510531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510531200000",
    "number": "1003329095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 N MARGIN ST APT 2",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021131638",
            "telephone_number": "203-710-7732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT STREET",
            "address_2": "FOUNDERS BUILDING SUITE 880",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02114",
            "telephone_number": "617-643-8281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANGO",
        "first_name": "JACQUELINE",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-13",
        "last_updated": "2017-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MA",
            "license": "120046",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "120046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Somdeb Banerjee
• Aleena Banerji, MD
• Caroline Rose Banevicius
• Jessica Miae Bang-Schaefer, PA-C
• Sungyon Bang, DMD
• Audrey Bangs, MD
• Nicholas Baniak, M.D
• Kimberly Reardon Banigan, CPNP
• Meredith G. Banigan
• Ayman Ahmed Z Banjar, BDS

• Clinical Social Worker in Boston, MA
• Providers in Boston, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2017; 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.