Tom Pedulla, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

111597 Issued in MA

Practice address

390 Massachusetts Ave
Arlington, MA 02474-6799

Phone

(617) 803-0951

Fax

(781) 643-0039

NPI assigned

Sep 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Thomas Pedulla Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1158451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590019200000",
    "number": "1053418608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "390 MASSACHUSETTS AVE",
            "city": "ARLINGTON",
            "state": "MA",
            "postal_code": "024746799",
            "telephone_number": "617-803-0951",
            "fax_number": "781-643-0039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "390 MASSACHUSETTS AVE",
            "city": "ARLINGTON",
            "state": "MA",
            "postal_code": "024746799",
            "telephone_number": "617-803-0951",
            "fax_number": "781-643-0039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDULLA",
        "first_name": "TOM",
        "name_prefix": "Mr.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-17",
        "last_updated": "2020-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "111597",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SSN",
            "identifier": "$$$$$$$$$",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THOMAS",
            "last_name": "PEDULLA",
            "credential": "LICSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Ann Peabody, LMHC
• Kristen Peacock
• Peak Performance Physical Therapy and Sports Medicine LLC
• Rachel Elizabeth Grace Pearson, MD
• Donna-Marie Peary, LMHC
• Elena Pellegrino, MA
• Michael Pellegrino, DPT
• Robert Pellerin
• Aldo Emilio Pena Moses, LMHC
• Anne L Pepper, LIC. AC.

• Clinical Social Worker in Arlington, MA
• Providers in Arlington, 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 May 21, 2020; 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.