NPIMap

Organization Active NPI

Nellie Broderick Licsw, LLC

  • Clinical Social Worker
  • Newton, MA
National Provider Identifier
1053921346
Registry record updated Aug 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
NELLIE BRODERICK LICSW, LLC
Practice address
77 Court St Apt 212
Newton, MA 02458-1465
Phone
(617) 823-5458
NPI assigned
Aug 3, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2020

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

Authorized official

Name
Nellie Catherine Broderick, LICSWNPI 1902416290
Title
Social Worker
Phone
(617) 823-5458

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

77 Court St Apt 212
Newton, MA 02458-1465

Mailing address

163 Highland Ave # 1006
Needham, MA 02494-3025
Phone (617) 823-5458

National Provider Directory

National Provider Directory

Locations

163 Highland Ave
#1006
Needham, MA 02494

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1596412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596412800000",
    "number": "1053921346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "163 HIGHLAND AVE # 1006",
            "city": "NEEDHAM",
            "state": "MA",
            "postal_code": "024943025",
            "telephone_number": "617-823-5458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 COURT ST APT 212",
            "city": "NEWTON",
            "state": "MA",
            "postal_code": "024581465",
            "telephone_number": "617-823-5458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NELLIE BRODERICK LICSW, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-03",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A",
        "authorized_official_last_name": "BRODERICK",
        "authorized_official_first_name": "NELLIE",
        "authorized_official_middle_name": "CATHERINE",
        "authorized_official_title_or_position": "SOCIAL WORKER",
        "authorized_official_telephone_number": "617-823-5458",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 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.