Individual provider Active NPI

Felipe Durand, LICSW

  • Clinical Social Worker
  • Brockton, MA
National Provider Identifier
1023240413
Registry record updated Apr 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
118349 Issued in MA
Practice address
165 Quincy St
Brockton, MA 02302-2988
Phone
(508) 897-2100
Fax
(508) 897-2135
NPI assigned
Aug 18, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 118349 MA Primary

Addresses

Primary practice location

165 Quincy St
Brockton, MA 02302-2988

Mailing address

1 Ridgehill LN
Sagamore Beach, MA 02562-2544
Phone (267) 265-2178

Other identifiers 1

IdentifierTypeStateIssuer
118349OtherMALICSW

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
118349MAMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1250553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429833600000",
    "number": "1023240413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 RIDGEHILL LN",
            "city": "SAGAMORE BEACH",
            "state": "MA",
            "postal_code": "025622544",
            "telephone_number": "267-265-2178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 QUINCY ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023022988",
            "telephone_number": "508-897-2100",
            "fax_number": "508-897-2135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DURAND",
        "first_name": "FELIPE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-18",
        "last_updated": "2015-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "118349",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICSW",
            "identifier": "118349",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2015; 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.