Active NPI
Phyllis Brooks, LICSW LIC 1043921
- Clinical Social Worker
- Wenham, MA
National Provider Identifier
1043374788
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LICSW 104392-1
- Practice address
- 225 Main Street
Wenham, MA 01984 - Phone
- (978) 468-0005
- Fax
- (978) 774-9218
- NPI assigned
- Dec 20, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LICSW 104392-1 | MA | Primary |
Addresses
Primary practice location
225 Main Street
Wenham, MA 01984
Mailing address
Envision Health and Healing
225 Main Street
Wenham, MA 01984
Phone (978) 468-0005
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 288764 | Other | MA | MHN |
| P03879 | Other | MA | BCBS |
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
| License | State | Type | Specialty |
|---|---|---|---|
| LICSW 104392-1 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043374788",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "ENVISION HEALTH AND HEALING",
"address_2": "225 MAIN STREET",
"city": "WENHAM",
"state": "MA",
"postal_code": "01984",
"telephone_number": "978-468-0005",
"fax_number": "978-774-9218"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 MAIN STREET",
"city": "WENHAM",
"state": "MA",
"postal_code": "01984",
"telephone_number": "978-468-0005",
"fax_number": "978-774-9218"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROOKS",
"first_name": "PHYLLIS",
"credential": "LICSW LIC 1043921",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "LICSW 104392-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHN",
"identifier": "288764",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "P03879",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wenham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.