Individual provider Active NPI

Nancy M Gibbons, LICSW

  • Clinical Social Worker
  • Stoughton, MA
National Provider Identifier
1073650990
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
1020270 Issued in MA
Practice address
966A Park St
Stoughton, MA 02072-3650
Phone
(781) 341-0923
Fax
(781) 341-0994
NPI assigned
Jan 31, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 1020270 MA Primary

Addresses

Primary practice location

966A Park St
Stoughton, MA 02072-3650

Mailing address

511 Central St
East Bridgewater, MA 02333-2023
Phone (508) 350-0028

Other identifiers 1

IdentifierTypeStateIssuer
P06689OtherMABCBSMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070413000100 MA Practitioner - Clinical Social Worker 6103921515 Practice locations: Norwood, MA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1 Walpole St
Suite 5
Norwood, MA 02062-3315
Phone (781) 492-9893

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1020270MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Adult & Child Counseling Associates Clinical Past Accepting new patients
Veterans Administration Past Accepting new patients
Mary C. Tarvin, MSW, Licsw, P.C. Clinical Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073650990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 CENTRAL ST",
            "city": "EAST BRIDGEWATER",
            "state": "MA",
            "postal_code": "023332023",
            "telephone_number": "508-350-0028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "966A PARK ST",
            "city": "STOUGHTON",
            "state": "MA",
            "postal_code": "020723650",
            "telephone_number": "781-341-0923",
            "fax_number": "781-341-0994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBBONS",
        "first_name": "NANCY",
        "middle_name": "M",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "1020270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSMA",
            "identifier": "P06689",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stoughton, MA

Sources for this page

Verify at the official NPI Registry.