Active NPI
Amanda Proctor, LICSW
- Clinical Social Worker
- Boston, MA
National Provider Identifier
1063908804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 119906
- Practice address
- 105 Chauncy St Ste 302
Boston, MA 02111-1771 - Phone
- (617) 879-8361
- NPI assigned
- Jul 5, 2018
- Sex
- Female
- Sole proprietor
- No
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 | 119906 | MA | Primary |
Addresses
Primary practice location
105 Chauncy St Ste 302
Boston, MA 02111-1771
Mailing address
232 Mystic St
Arlington, MA 02474-1102
Phone (203) 451-5509
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 |
|---|---|---|---|
| 119906 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1530748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530748800000",
"number": "1063908804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "232 MYSTIC ST",
"city": "ARLINGTON",
"state": "MA",
"postal_code": "024741102",
"telephone_number": "203-451-5509"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 CHAUNCY ST STE 302",
"city": "BOSTON",
"state": "MA",
"postal_code": "021111771",
"telephone_number": "617-879-8361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROCTOR",
"first_name": "AMANDA",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-05",
"last_updated": "2018-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "119906",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 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.