Tegan Mallary Polhamus, LICSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

120986 Issued in MA

Practice address

3 Blackburn Center
Gloucester, MA 01930

Phone

(978) 283-7793

NPI assigned

Jun 30, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Tegan Mallary Walsh Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Justice Resource Institute, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Acton, MA
  • NPI 1295909760
  NPD (past)

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

{
    "created_epoch": "1309392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517270400000",
    "number": "1063709806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 BLACKBURN CENTER",
            "city": "GLOUCESTER",
            "state": "MA",
            "postal_code": "019305040",
            "telephone_number": "978-283-7793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 BLACKBURN CENTER",
            "city": "GLOUCESTER",
            "state": "MA",
            "postal_code": "01930",
            "telephone_number": "978-283-7793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLHAMUS",
        "first_name": "TEGAN",
        "middle_name": "MALLARY",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-30",
        "last_updated": "2018-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MA",
            "license": "221026",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MA",
            "license": "120986",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TEGAN",
            "last_name": "WALSH",
            "middle_name": "MALLARY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Emily Philpott
• Phoenix Healthcare, LLC
• Gabriella Picariello
• Elizabeth Pierce
• Richard L Pinegar Jr., M.D.
• Conor Michael Powers
• Michael James Powers, DDS
• Rachel Pozzar, MSN, FNP-BC
• Robert Campbell Preston, DDS
• David L. Probert, P.A.

• Social Worker in Gloucester, MA
• Providers in Gloucester, MA by specialty
• Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2018; 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.