Active NPI
Alex Gerrish, LICSW
- Clinical Social Worker
- Jamaica Plain, MA
National Provider Identifier
1043752728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 121740
- Practice address
- 3464 Washington St
Jamaica Plain, MA 02130-2665 - Phone
- (781) 561-0205
- NPI assigned
- Nov 10, 2016
- Sex
- Unspecified or another gender identity
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 221989 | MA | |
| Clinical Social Worker | 1041C0700X | 121740 | MA | Primary |
Addresses
Primary practice location
3464 Washington St
Jamaica Plain, MA 02130-2665
Mailing address
3464 Washington St
Jamaica Plain, MA 02130-2665
Phone (781) 561-0205
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110149004A | Medicaid | MA |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 221989 | MA | MD | Mental Health Counselor |
| 121740 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1478736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733875200000",
"number": "1043752728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3464 WASHINGTON ST",
"city": "JAMAICA PLAIN",
"state": "MA",
"postal_code": "021302665",
"telephone_number": "781-561-0205"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3464 WASHINGTON ST",
"city": "JAMAICA PLAIN",
"state": "MA",
"postal_code": "021302665",
"telephone_number": "781-561-0205"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GERRISH",
"first_name": "ALEX",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "X",
"enumeration_date": "2016-11-10",
"last_updated": "2024-12-11",
"certification_date": "2024-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MA",
"license": "221989",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "121740",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110149004A",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jamaica Plain, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.