Active NPI
Dieumy Phan, LICSW
- Social Worker
- Boston, MA
National Provider Identifier
1073098141
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 116947
- Practice address
- 300 The Fenway
Boston, MA 02115-5820 - Phone
- (617) 521-3943
- NPI assigned
- Sep 25, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 116947 | MA | Primary |
Addresses
Primary practice location
300 The Fenway
Boston, MA 02115-5820
Mailing address
25 Mount Vernon St # 1
Dorchester, MA 02125-1604
Phone (857) 544-3619
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 |
|---|---|---|---|
| 116947 | MA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1537833600000",
"number": "1073098141",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 MOUNT VERNON ST # 1",
"city": "DORCHESTER",
"state": "MA",
"postal_code": "021251604",
"telephone_number": "857-544-3619"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 THE FENWAY",
"city": "BOSTON",
"state": "MA",
"postal_code": "021155820",
"telephone_number": "617-521-3943"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "DIEUMY",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-09-25",
"last_updated": "2018-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MA",
"license": "116947",
"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 Sep 25, 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.